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CHAMPIX can help your 
mild to moderate COPD 
patients stop smoking 1 

«2> 91 % of middle-aged smokers exhibit one or more 
symptoms of COPD 2 

^> Smoking cessation is the single most effective 
intervention to reduce risk of COPD development 
and progression 3 

|| 20 
o 10 


CHAMPIX vs. placebo OR = 8.4 
195% CI: 4.99-14.14), p<0 0001 

CHAMPIX 1 mg bd (n=248) 

placebo ln=251t 

O In a 27 centre, double-blind, multinational study 
investigating patients with mild-moderate COPD who 
smoked an average of 24 cigarettes/day over the past 
month for an average of 41 years: 1 * 

o CHAMPIX provided ~8x greater odds of stopping 
smoking after 1 2 weeks of treatment vs. placebo 
(OR = 8.40; 95% CI: 4.99-14.14, p<0.0001)< 

o After one year, 18.6% of patients treated with 

CHAMPIX remained smoke-free, vs. 5.6% treated with 
placebo (OR = 4.04; 95% CI: 2.13-7.67, p^.0001) 1 

•Adapted from Tashkin D et al. Presented at.CHEST, 2009. A 27 centre, double-blind, multinational study 
investigated CHAMPIX vs. placebo for smoking cessation in mild to moderate COPD patients (post- 
bronchodilator FEV/FEV <70% and FEV,% predicted normal value 2:50%). Subjects received either 
CHAMPIX 1 mg bd or placebo for 12 weeks, with a 40-week non-treatment follow-up. Primary endpoint 
was CO-confirmed continuous abstinence rate for weeks 9-12. Mean patient baseline characteristics 
ItSD): number cigs/day over past month 24 (±1 1 ); smoking duration 41 (±9) years. 


varenicline tartrate 

CHAMPIX Fitm-Coated Tablets (varenicline tartrate) ABBREVIATED PRESCRIBING 
INFORMATION - UK. (See Champix Summary of Product characteristics for full 
Prescribing Information). Please refer to the SmPC before prescribing Champix 
0.5 mg and 1 mg. Presentation: White, capsular-shaped, biconvex tablets 
debossed with "Pfizer" on one side and "CHX 0.5" on the other side and light 
blue, capsular-shaped, biconvex tablets debossed with "Pfizer on one side 
and "CHX 1.0" on the other side. Indications: Champix is indicated tor smoking 
cessation in adults. Dosage: The recommended dose is 1 mg varenicline twice 
daily following a 1-week titration as follows: Days 1-3: 0.5 mg once daily. Days 
4-7: 0.5 mg twice daily and Day 8-End of treatment: 1 mg twice daily. The patient 
should set a date to stop smoking. Dosing should start 1-2 weeks before this 
date. Patients who cannot tolerate adverse effects may have the dose lowered 
temporarily or permanently to 0.5 mg twice daily. Patients should be treated with 
Champix for 12 weeks. For patients who have successfully stopped smoking 
at the end of 12 weeks, an additional course of 12 weeks treatment at 1 mg 
twice daily may be considered. Following the end of treatment, dose tapering 
may be considered in patients with a high risk of relapse. Patients with renal 
insufficiency: Mild to moderate renal impairment No dosage adjustment is 
necessary. Patients with moderate renal impairment who experience intolerable 
adverse events. Dosing may be reduced to 1 mg once daily. Severe renal 
impairment: 1 mg once daily is recommended. Dosing should begin at 0.5 mg once 
dailyforthefirst3 days then increased to 1 mg once daily. Patients with end stage 
renal disease: Treatment is not recommended. Patients with hepatic impairment 
and elderly patients: No dosage adjustment is necessary Paediatric patients: 
Not recommended in patients below the age of 18 years. Contraindications: 
Hypersensitivity to the active substance or to any of the excipients. Warnings 
and precautions: Effect of smoking cessation: Stopping smoking may alter 
the pharmacokinetics or pharmacodynamics of some medicinal products, for 
which dosage adjustment may be necessary (examples include theophylline, 
warfarin and insulin}. Changes in behaviour or thinking, anxiety, psychosis, mood 
swings, aggressive behaviour, depression, suicidal ideation and behaviour and 
suicide attempts have been reported in patients attempting to quit smoking with 

Champix in the post-marketing experience. Not all patients had stopped smoking 
at the time of onset of symptoms and not all patients had known pre-existing 
psychiatric illness. Champix should be discontinued immediately if agitation, 
depressed mood or changes in behaviour or thinking that are of concern for the 
doctor, the patient, family or caregivers are observed, or if the patient develops 
suicidal ideation or suicidal behaviour. In many post-marketing cases, resolution 
of symptoms after discontinuation of varenicline was reported, although in some 
cases the symptoms persisted; therefore, ongoing follow up should be provided 
until symptoms resolve. Depressed mood, rarely including suicidal ideation and 
suicide attempt, may be a symptom of nicotine withdrawal. In addition, smoking 
cessation, with or without pharmacotherapy, has been associated with the 
exacerbation of underlying psychiatric illness (e.g. depression). The safety and 
efficacy of Champix in patients with serious psychiatric illness has not been 
established. There is no clinical experience with Champix in patients with 
epilepsy. At the end of treatment, discontinuation of Champix was associated 
with an increase in irritability, urge to smoke, depression, and/or insomnia in 
up to 3% of patients, therefore dose tapering may be considered. There have 
been post-marketing reports of hypersensitivity reactions including angioedema 
and reports of rare but severe cutaneous reactions, including Stevens-Johnson 
Syndrome and Erythema Multiforme in patients using varenicline. Patients 
experiencing these symptoms should discontinue treatment with varenicline 
and contact a healthcare provider immediately. Pregnancy and lactation: 
Champix should not be used during pregnancy. It is unknown whether varenicline 
is excreted in human breast milk. Champix should only be prescribed to 
breast-feeding mothers when the benefit outweighs the risk. Driving and 
operating machinery: Champix may have minor or moderate influence on the 
ability to drive and use machines. Champix may cause dizziness and somnolence 
and therefore may influence the ability to drive and use machines. Patients are 
advised not to drive, operate complex machinery or engage in other potentially 
hazardous activities until it is known whether this medicinal product affects their 
ability to perform these activities. Side-Effects: Adverse reactions during clinical 
trials were usually mild to moderate. Most commonly reported side-effects 

were abnormal dreams, insomnia, headache and nausea. Commonly reported 
side-effects were increased appetite, somnolence, dizziness, dysgeusia, vomiting, 
constipation, diarrhoea, abdominal distension, stomach discomfort, dyspepsia, 
flatulence, dry mouth and fatigue. See SmPC for other less commonly reported 
side effects. Overdose: Standard supportive measures to be adopted as required. 
Varenicline has been shown to be dialyzed in patients with end stage renal 
disease, however, there is no experience in dialysis following overdose. Legal 
category: POM Basic NHS cost: Pack of 25 11 x 0,5 mg and 14 x 1 mg tablets 
Card (EU/1/06/360/003) £27.30. Pack of 28 1 mg tablets Card (EU/ 1/06/360/004) 
£27.30. Pack of 56 0,5 mg tablets HDPE Bottle (EU/1/06/360/001) £54.60. Pack of 
56 1 mg tablets HDPE Bottle (EU/1/06/360/002) £54.60. Pack of 56 1 mg tablets 
Card (EU/ 1/06/360/005) £54.60. Not all pack sizes may be marketed / marketed 
at launch Marketing Authorisation Holder: Pfizer Limited, Sandwich, Kent, CT13 
9NJ, United Kingdom. Further information on request: Pfizer Limited, Walton Oaks, 
Dorking Road, Tadworth, Surrey, KT20 7NS. Last revised: 11/2009 Ref: CI7_0. 

Adverse events should be reported. Reporting forms and information 
can be found at Adverse events should 
also be reported to Pfizer Medical Information on 01304 616161. 

For further information, please contact Pfizer Medical Information on 01304616161 or 

References: 1. Tashkin D era/. Efficacy and safety of varenicline for smoking cessation 
in patients with mild to moderate Chronic Obstructive Pulmonary Disease (COPD). 
Poster Abstract Presented at CHEST, Oct 31st - Nov 5th, 2009, San Diego, California: 
Abstract 1054. 2. Calverley PMA. COPD: Early Detection and Intervention. Chest 2000; 
117:365S-371S. 3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 
Pocket guide to COPD diagnosis, management and prevention. A guide for healthcare 
professionals. Updated 2008. 

Date of preparation: January 2010 CHA851b ©Pfizer 2009 

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Health matters. A year ago Barack 
Obama's plan for US healthcare 
reforms was the water cooler topic 
of choice. This month the chatter is 
a little closer to home as the 
Conservatives focus on health in the 
first part of their election assault. 

Shadow health secretary Andrew 
Lansley, a man who seems well- 
informed about community 
pharmacy, has set out his party's 
plans to tackle public health issues 
such as obesity and drug use in their 
green paper on public health (p8). 

As you'd expect, it makes all the 
right noises and talks about an 
expanded NHS role for pharmacists, 
as well as praising pharmacists for 
being the public's most frequent link 
to a "knowledgeable healthcare 

Now whether this represents a 
sure-fire opportunity to advance 
community pharmacy under a new 
government, or if it's just a political 
wish that has little chance of 
becoming cast iron policy, your 
guess is as good as mine. 

But for the majority of 
contractors, the general election is 
still a distant concern and it's the 
swathe of red appearing across 
pharmacy P&L accounts that is 
keeping them awake at night. 

No one will disagree that the 
past 12 months has been an 
annus horribilis for the sector. 
Redundancies and pay freezes 
coming on top of soaring workloads 
are what 2009 will be remembered 
for by many of our colleagues. So 
the news that the cost of service 

inquiry has finally begun will come 
as welcome relief (p5). 

This week the C+D Senate 
debated the issue of pharmacy 
finance. The full write-up will appear 
shortly, but suffice to say the 
Senators were pretty forthright in 
their views. Rising workloads within 
a finite amount of cash just don't 
equate. It's no longer about 
providing value for money; it's more 
about ensuring patient safety isn't 
compromised by the continual cuts 
in funding. 

Whichever party takes the reins, 
they'll find a willing, ready and able 
partner in community pharmacy, but 
only at a fair price. 

Just when will the CPhC launch? 

Duncan Rudkin is a name that will 
become increasingly familiar to 
pharmacists. The chief executive of 
the new regulator, the General 
Pharmaceutical Council (GPhC), 
has given his first interview and he 
reveals that it's impossible to say 
with any certainty just when the 
GPhC will go live. 

And with the revelation this week 
(p4) that the draft Pharmacy Order 
faces a delay after Lord Scott of 
Foscote challenged the right of 
inspectors to search pharmacy 
premises without the owner's 
permission or a warrant, perhaps it's 
for the best that the launch is put 
back - even if just for a few weeks. 

After all, April 1 was never a great 
choice as a launch date. 

Gary Paragpuri, Editor 

4 GPhC launch delayed 

5 Cost of service inquiry seeks data 

6 'Pay us to fix medicines adherence' 
8 Cat M compensation bid in Nl 

10 An insight into generic substitution 
12 Product and market news 
14 Xrayserand David Reissner 
25 Classified 
30 Postscript 

16 Update: Your guide to stoma care 

Part two: choosing the right appliance 

18 Practical Approach 

Complementary medicines for coughs and colds? 

19 Footcare 

Grab yourself a share of this £19m market 

22 How to handle your rent review 

Your rights and responsibilities 

24 C+D Awards 2010 

Meet last year's Pharmacy Assistant of the Year 

26 Careers 

this publication may be reproduced or transmuted in any form or by any means, electronic or mechanical including photocopying recording or any ^^^^^''^^^X^L sup2rs f vou do not w h 
Press. Queens Road. Ashford TN24 8HH. Registered at the Post Office as a Newspaper. Volume 273 No 6731 


GPhC launch delayed as fears 
surface over search powers 

EXCLUSIVE Pharmacists must wait beyond April for new regulator, confirm insiders 

Duncan Rudkin: still hurdles to clear before we can name a launch date 

Rudkin: expect flexible regulatory 
style that won't stifle innovation 

Chris Chapman 

The launch of pharmacy's new 
regulator will be delayed after fears 
inspectors would be granted 
excessive powers. 

The General Pharmaceutical 
Council (GPhC) is set to miss its 
April launch date after an objection 
from the House of Lords over 
powers in the draft Pharmacy 
Order 2010. 

Lord Scott of Foscote challenged 
the order as it gives inspectors the 
right to enter and search pharmacy 
premises without the permission of 
the owner or a warrant from a judge 
or magistrate. 

Speaking to C+D, Lord Scott said 
he "cannot understand the need" for 
the powers and his opposition had 
caused the order to be delayed. 

A senior source close to the 
GPhC told C+D that the launch 
could be pushed as far back as 
June. A senior figure in the 
Department of Health confirmed 

Call for Scots 
Hep C screening 
service rollout 

Hepatitis C screening should be a 
national pharmacy service in 
Scotland, a leading charity has said. 

The Hepatitis C Trust has called on 
all Scottish health boards to pilot 
offering the tests in community 
pharmacies, following a successful 
trial across five PCTs in England. 

The 15 per cent detection rate in 
the England trial (C+D, January 16, 
p7) was far higher than the 2.5 per 
cent from the 70,000 tests in 
Scotland in 2008, the trust noted. 

"Tests in pharmacies could help 
find patients who would otherwise 
not get tested and they are the ones 
at real risk of death," said the trust's 
chief executive Charles Core. JR 

See how pharmacists 
set up Hep C pilots 


the launch date will be delayed. 

Speaking exclusively to C+D, 
GPhC chief executive Duncan Rudkin 
said parliamentary processes made 
it impossible to set a firm date for 
the GPhC's launch. The confusion 
was unsettling for pharmacists, Mr 
Rudkin said. However, he had made 
a pact with himself not to speculate 
on a launch date. 

He added: "There are still hurdles, 
in my mind, to go through before we 
get to that point [naming a date]. 
So the commitment is as soon as 

The House of Lords is the final 
body required to approve the draft 
Pharmacy Order before the Privy 
Council, following the go-ahead 
from the Scottish parliament last 
year and the House of Commons on 
Monday. The Lords is now set to 
approve the draft Pharmacy Order 
on February 1. 

Currently, RPSCB inspectors have 
the power to enter and search 
premises, but only under a 
Department of Health warrant. 

Pharmacy's future regulator has 
pledged regulation will be clear and 
flexible, after pharmacy bodies 
branded its draft standards 
"unwieldy" and a potential 
"bureaucratic strait jacket". 

The commitment followed 
responses by pharmacy bodies to 
the consultation on the proposed 
standards for the GPhC, which 
closed last week. 

Speaking exclusively to C+D, 
GPhC chief executive Duncan Rudkin 
declined to comment on the 
criticism of the standards by the 
NPA and the Institute of Pharmacy 
Management. However, he 
emphasised regulation would be 
clear and proportional. 

He said: "You can expect from the 
GPhC council regulation in a way 
that's proportionate. That's trotted 
out like motherhood and apple pie 
by regulators, but I think it's real. 

"And that means we will do what's 

necessary, but won't close down or 
try to stifle professionalism or 

"We have got to have scope for 
how we advance, and sometimes 
that means advancing on the 
boundaries of what was previously 
considered historically acceptable 
and normal," Mr Rudkin added. 

The comments follow hostile 
responses to the proposed GPhC 
standards last week. The NPA 
branded proposals "unwieldy". 
Margaret Peycke, NPA external 
relations manager, said: "The 
document as it now stands lacks 
both clarity and consistency and 
some sections appear in a more 

finished form than others." 

Meanwhile, the Institute of 
Pharmacy Management warned 
that standards could create a 
"bureaucratic strait jacket" for 

The RPSGB national boards 
have also slammed the draft 
standards, labelling the proposals 
"exceptionally disappointing" and 
"neither flexible nor broad enough to 
allow practising pharmacists to 
apply them". 

More than 170 responses had 
been received over the consultation, 
Mr Rudkin said, adding that it was a 
tribute to pharmacy that interest 
had been so strong. CC 

t the latest on pharmacists' 
ic battles against the snow 


Are you an exceptional pharmacy talent? Tell us about it 

^^^^S|^r www chcmistsnodnj^^ist co uk/3W3rds 


Cost of service inquiry 
seeks contractor input 

EXCLUSIVE Accountancy firm asks 500 pharmacies for business data 

Zoe Smeaton 

PricewaterhouseCoopers (PwC) has 
begun contacting pharmacy 
contractors as it carries out the 
sector's cost of service inquiry, the 
Department of Health (DH) has 

Accountancy firm PwC was 
appointed by the DH and PSNC 
to carry out the inquiry last year, 
after contractors complained that 
the pharmacy contract in England 
was underfunded. 

The firm is now seeking a sample 
of 500 pharmacies to take part and 
has written to contractors from a 
spectrum of ownerships, sizes and 
locations, the DH said this week. 

The survey will include both a 
questionnaire and a supporting 
telephone conversation, with 
questions focusing on the costs of 
conducting the business. 

Contractors taking part will be 
asked about the services they provide, 
staffing structure and future plans, 
as well as having to submit a copy of 
their latest financial accounts. 

The DH could not confirm how 
long it would take participating 
pharmacies to complete the 
questionnaire but said the data 
sought was "comprehensive". 

However, it stressed that 
questionnaires were clear and that 
the telephone conversation would 
take contractors through them. 

The DH and PSNC have urged 
contractors contacted to help to 
provide detailed responses. A DH 
spokesperson said: "It is essential 
that the costs of the range of 
pharmacy businesses today are 
captured fully, as well as identifying 
the costs of future developments in 
the community pharmacy service." 

PwC is expected to deliver the 
results of the inquiry in April. 

Have you been asked to 
take part in the cost of 
service inquiry? 

C+D has beaten its rivals by 
scooping two of the three 
awards at the inaugural Avicenna 
Media Awards, held in London 
last week. As well as winning 
Publication of the Year, C+D's 
features editor Jennifer 
Richardson won Young Pharmacy 
Writer of the Year. Avicenna CEO 
Salim Jetha said of C+D: "There is 
always one title that I, like my 
fellow professionals, will pick up 
for the latest news, views and 
snippets of information." Mr 
Jetha, pictured left with Jennifer 
Richardson and C+D editor Gary 
Paragpuri at the event, also 
praised C+D's website, adding: "I 
like the way C+D has developed 
its content online and I can keep 
tabs on the latest news quickly 
and easily." 

Thief poses as pharmacy worker 

Pharmacists in the Hounslow area 
have been alerted to a thief posing 
as a member of pharmacy staff. 

Last week a woman stole 
handbags from two elderly women 
after posing as a pharmacy worker 
to gain access to their houses, 
contractors were told. 

Inspector Manpreet Bains, of 
Hounslow Police Station, said a 
further two incidents had been 
reported this week, one in Feltham 

and another in nearby Heston, 

He said: "She claims to be from a 
local pharmacy and either says she 
can collect their prescription or asks 
them for information." 

In one case the woman had 
claimed to be offering the help to 
assist patients in the adverse 
weather conditions, he added. 

Inspector Bains said the police had 
informed pharmacies in the area and 

he advised that they could warn 
patients to call the pharmacy with 

Uma Patel, of Dunns Chemist in 
Hounslow, said pharmacists in the 
area had been given a description 
of the thief and asked to look out 
for her. 

Pharmacists with information 
have been asked to call Hounslow 
police on 0300 123 1212 and quote 
CAD 3131 of Jan 12. ZS 

Error prosecutions 

The MHRA and Crown Prosecution 
Service are in the "final stages" of 
agreeing guidance for prosecutors 
to use when considering 
dispensing errors, as promised 
after the Elizabeth Lee case. 

Platinum Design Awards 

If your pharmacy, or one of your 
company's pharmacies, has been 
refitted to an exceptional 
standard since January 2008 you 
could win £6,000. Get full details 
on the Platinum Design Awards at: 

Rituximab in Scotland 

Rituximab is now available to 
patients with relapsed or refractory 
chronic lympocytic leukaemia in 
Scotland, following approval by the 
Scottish Medicines Consortium. 
Guidance on rituximab from Nice 
is expected in April. 

Electronic cigarette doubt 

More research is required into the 
safety and long-term effect of 
electronic cigarettes, researchers 
have said. The comments, on the 
BMJ website, warn knowledge of 
the devices' acute and long-term 
effects is "at best, very limited". 

NPA tackles red tape 

The NPA will hold a members' 
meeting to discuss administration 
and paperwork in community 
pharmacies. The meeting, which 
will look for ways to reduce 
bureaucracy, is at Mallinson House, 
St Albans on February 16. To attend, 

Cancer care 

The DH has launched an initiative 
to give all cancer patients a 
personalised assessment and care 
plan. The initiative, in partnership 
with Macmillan Cancer Support, 
commits to ensuring all patients 
with cancer will have personalised 
support to self-manage their 
condition by 2012. 


The patent for atorvastatin 
(Lipitor) expires in 2011 and not 
2010 as stated in C+D, January 
9, p21. 



More news online 

Pay us to fix medicines 
adherence, says sector 

Pharmacists can cut waste with funding and training, APPG hears 

Professor Nick Barber: pharmacists must be "appropriately remunerated' 

put to the 
public vote 

More than eight in 10 patients 
believe generic medicines are 
equally as effective as brands, a 
European survey has found. 

The study was published as 
pharmacists raised concerns over 
patients' potential reactions to 
changes to their regular medicines 
under government plans for generic 
substitution. PSNC said this could 
cause "substantial difficulties". 

But seven out of 10 participants in 
the survey, completed by 2,800 
patients in seven European countries 
including Britain, claimed to know 
the difference between generic and 
branded medicines. The proportion 
was higher in the better educated, 
the over-45s and men. 

But more than 40 per cent doubted 
that generics contained the same 
active components as the original 
brand, Belgian marketing consultancy 
Insites Consulting found. JR 

Get your guide to 
generic substitution 

See plO 

Governance guide 

PSNC has launched a training 
workbook to help contractors 
meet their information 
governance (IC) requirements, 
which they must begin working 
towards by the end of March. 

Supply deal renewed 

AstraZeneca has renewed its 
direct to pharmacy distribution 
deal with AAH and Alliance 
Healthcare for another four years. 

Mystery shop tests 

Numark has launched a mystery 
shopping service that will use real 
patients and form the next level of 
the group's training programme 
for counter staff. The quarterly 
mystery shops cost £150 a year 
and will score customer service. 

Zoe Smeaton 

Improving medicines adherence 
needs to be prioritised and resources 
should be freed up to enable 
pharmacists to help patients take 
medicines correctly, industry leaders 
have concluded. 

A meeting of the all-party 
pharmacy group (APPG) this week 
heard that pharmacists should 
become experts in patients, as well 
as in medicines, and spend more 
time improving adherence. 

Ash Soni, a community 
pharmacist in London, said 
pharmacists could dedicate more 
time to talking to patients who had 
been newly prescribed medicines for 
long-term conditions. 

But others warned the role will 
require specialist training and could 
be a "real commissioning challenge". 

Rob Home, professor of 
behavioural medicine at the School 
of Pharmacy, University of London, 
said the role was more than just 
giving information. "It's making 

The 100-hour pharmacy exemption 
has been brought to the attention of 
ministers once again following a 
local campaign against an 
application made in Nottingham. 

Graham Allen MP issued a 
parliamentary question last week 
asking whether the government 
will bring forward proposals to 
protect small pharmacy businesses 
from the effects of in-house 
pharmacies opening in supermarkets. 

The move came after Mr Allen 
backed Mistry's Pharmacy in 
Nottingham when Tesco applied to 
open a 100-hour dispensary in its 
store next to the pharmacy. Patients 
campaigned to save Mistry's, 
launching a petition and creating a 
"bit of a hubbub", Mr Allen said. 

Tesco has withdrawn the 
application but said while it was 
aware of the petition it had made 
the decision to withdraw 

the information plausible, telling 
a story about that treatment 
that convinces the individual that 
they need it." 

And pharmacists needed to be 
"appropriately remunerated" and 
given the training and skills to deliver 
any such service effectively, 
according to professor Nick Barber 
of the School of Pharmacy. 

PSNC confirmed it was still in 
"amicable negotiations" with NHS 

"independently" and for operational 

Dayaram Mistry, the contractor at 
the pharmacy, said this had been a 
"big weight off his shoulders". But he 
said he remained cautious as the 
supermarket could submit another 
application later. "It's really difficult 
at the moment so I'm trying to 
continue supporting our patients," 
he told C+D. 

In spring 2011, legislative changes 
will give PCTs greater say on 
contract applications. But pharmacy 
minister Mike O'Brien has said that 
until then the 100-hour loophole 
will continue. ZS 

Top lawyer names 2009's 
biggest legal events 

See p14 

Employers on developing a role for 
pharmacy in helping patients taking 
new medicines for a long-term 

And RPSGB chief executive and 
registrar Jeremy Holmes announced 
that the Society had commissioned 
research on the subject from Alison 
Blenkinsopp, professor of practice 
of pharmacy at Keele University, 
which could aid commissioning 
of services. 

Flu rates lower 
than last winter 

Rates of flu-like illness in 
England are lower than last 
year and only two thirds of those 
expected despite the threat of 
swine flu, the Health Protection 
Agency (HPA) has said. 

According to latest figures, the 
rate of GP consultations for flu- 
like illness was only 19.9 per 
100,000, compared with an 
expected seasonal level of 
30 per 100,000. 

There had also been a 
small decrease in the number 
of assessments, antiviral 
authorisations and collections 
through the National 
Pandemic Flu Service, the 
HPA said. 

When asked if the decreased 
rates of flu-like illness had made 
an impact on OTC cough and 
cold remedies, the PAGB said 
sales were similar to last year. 
Boots declined to comment on 
sales information. CC 

100-hour exemption 
back in the limelight 



visceral fat loss - at the centre 
of weight loss and health gain? 

Targeting "hidden" fat should be an important weight loss 
goal for those at risk of obesity-related health problems. 

Subcutaneous fat, which lies just 
beneath the skin, is the visible 
fat that everyone wants 
to lose. But research 
focuses our attention 
on a much more 
dangerous kind 
of fat: the visceral 
fat surrounding 
the organs in 
the chest and 
abdomen.' 3 

Visceral fat 
cells produce 
many chemical 
messengers that 
affect metabolic 
and circulatory 
pathways 4 " There is a 
clear relationship between 
excess visceral fat and the risk 
of type 2 diabetes and cardiovascular 
disease. 1 " 3 

The good news is that losing weight with 
a reduced calorie, lower-fat diet - with 
or without the help of alii, a weight loss 
aid for overweight adults with a BMI > 28 
kg/m 2 - can reduce visceral fat mass. 6 ' 8 
Studies show that exercise alone can 

also reduce visceral fat in men" and 
women;" further encouragement 
for overweight people to 
ncrease their activity 

This knowledge can 
i icip pridiiTidcy 
advise and 
motivate their 
customers on the 
importance of a 
healthy lifestyle. 
The important 
message is this: 
weight loss helps 
people lose both 
subcutaneous and 
visceral fat, but it is the 
latter that brings significantly 
greater health benefits. 1 

GSK has examined the effect of the 
combination of alii and a reduced 
calorie, lower-fat diet 
in visceral fat loss. 
The results are soon 
to be published, 
so watch this 

60 mg hard capsules 



Ofrr (35^ 

Product Information, alii 60 mg hard capsules (orlistat). Indication: Weight li 
in adults BMI > 28 Dosage: Adults (18 or over): One capsule within an hour of 
each of three main meals. Max. 3 caps/day for up to 6 months. Use with lower 
fat mildly hypocaloric diet. If no weight loss within 12 weeks refer to HOP Diet 
and exercise should start prior to treatment Contraindications Hypersensitivity 
to ingredients; concurrent treatment with oral anticoagulants or ciclosporin; 
chronic malabsorption syndrome; cholestasis; pregnancy, breast-feeding. 
Special warnings and precautions: See GP if kidney disease, on amiodarone, 
levothyroxine or medication for diabetes or epilepsy See HOP if on medication 
for hypertension or hypercholesterolemia. Risk of Gl symptoms increases with 
fat consumption Take multivitamin at bedtime. See GP if rectal bleeding. Oral 
contraceptive efficacy may be reduced if severe diarrhoea; use additional 
contraception Drug interactions: Ciclosporin, oral anticoagulants, levothyroxine, 

antiepileptics, fat soluble vitamins, acarbose, amiodarone Pregnancy and 
lactation: Do not use during pregnancy or lactation Side effects See SPC for full 
details. Predominantly gastrointestinal eg oily stools, urgency; usually mild and 
transient, risk reduced by low fat consumption. Pancreatitis, oxalate nephropathy, 
hepatitis, cholelithiasis, abnormal liver enzymes, anxiety, hypersensitivity reactions 
including anaphylaxis, bronchospasm, angioedema, pruritus, rash, and urticaria; 
bullous eruption. Legal category P Marketing Authorisation Holder Glaxc 
Group Limited, Greenford, Middlesex, UB6 ONN MA Number: EU/1/07/401/007 & 
009. Pack size and RSP (excl. VAT): 42s £2865, 84s £43.43. Last revised: November 
2009. References 1. Larsson B et a/ Br Med J 1984; 288 1401-1404 2 Yusuf S, 
et a/. Lancer 2004, 364: 937-52 3. Wang Y et a/. Am J Clin Nutr 2005; 81: 555-63. 
4. Kershaw E et al. J Clin Endocrinol Metab 2004; 89 2548-2556 5 Chandran 
M et al. Diabetes Care 2003; 26: 2442-2450. 6 Purnell J et al J Clin Endocrinol 
Metab 2000, 85: 977-82. 7 Goodpaster B et al Diabetes 1999; 48 839-47 8 Ross 
R eta/. Ann Intern Med 2000; 133: 92-103. 9 Ross A et al. Obesity Research 2004; 
12. 789-798 10. Park HS, Lee K. Diabetic Med 2004, 22: 266-72. 

alii is a registere 

le GlaxoSmithKline group of companies 


Get your Platinum Design Awards entries to us by February 1 


Will you be voting in 
the RPSGB elections? 

"Yes, possibly, it's a bit last minute 
now. But it's important. You 
complain things don't get done, but 
if you vote someone in you get to 
have a say." 

Jennifer Reid, Fairoak Pharmacy, 
Streatham, London 

"I haven't yet but I know who I'll 
vote for. This election is important. 
We need the new body to represent 
all pharmacists, whether in the 
community, in hospitals or in 

Gurminder Sail, Jeeves Chemist, 

Web verdict 

Yes, I already have 51% 

Yes, but I haven't voted yet 17% 

No 32% 

Armchair view: If actual voter 
turnout echoes the results of C+D's 
poll, the Society had better start 
recruiting extra ballot counters. 
Over two thirds say they will vote 
at this year's elections compared 
to previous turnouts of below 20 
per cent. 

Next week's question: 

At what age do you plan to retire? 

Vote at 

Nl contractors launch 
Cat M compensation bid 

PCC targets a deal with health bosses after legal victory 

Max Cosney 

Northern Ireland (Nl) contractors 
are set to lodge a claim worth tens 
of millions of pounds for money lost 
to illegal category M profit raids. 

The compensation bid comes 
after a High Court judge earlier this 
month ruled health bosses had used 
the mechanism "unlawfully". 

Pharmacy leaders have vowed to 
negotiate a settlement deal with 
NTs department of health, the 
DHSSPS, "as soon as possible", C+D 
can reveal. 

Terry Hannawin, chief executive of 
the Pharmaceutical Contractors 
Committee (PCC), said: "Our 
intention is to reach a financial 
settlement with the department in 
light of the judgement so that 
monies unlawfully withheld can be 
distributed among contractors as 
soon as possible." 

A deal to compensate 
contractors for category M losses 
since 2007 could total "tens of 

Terry Hannawin: contractors' losses 
could total tens of millions 

millions", Mr Hannawin predicted. 

The DHSSPS said it would be 
contacting PCC in the coming weeks 
with a proposed way forward. A 
DHSSPS spokesperson added: "It 
would therefore be inappropriate to 
comment further at this time." 

His comments follow this month's 
landmark legal win for PCC over the 

Justice Declan Morgan ruled 

officials had unfairly applied a 
category M system that the court 
heard was "not fit for purpose in 
Northern Ireland". 

Local reimbursement prices had 
been linked to the Scottish Drug 
Tariff since 1994, but this had fuelled 
a funding shortfall after April 2006, 
the judge said. 

Once this became apparent the 
department had a legal duty to act, 
he ruled. 

Health officials had an obligation 
to publish a drug tariff that ensured 
pharmacists received fair and 
reasonable remuneration for the 
services and materials provided by 
them, the judge said. 

The DHSSPS was not excused of 
this duty because it could not agree 
with the PCC over fair remuneration, 
he added. 

The case included a letter from a 
department official to the PCC that 
stated: "On one point I think we are 
agreed: category M is not fit for 
purpose in Northern Ireland and we 
need to replace it." 

Christmas cheer for Alliance Boots 

Rising retail income in Boots UK 
stores helped Alliance Boots 
continue double digit growth in the 
run up to Christmas. 

The pan-European company saw 
over 10 per cent revenue growth in 
the final quarter of 2009, the third in 
the financial year, group chief 
executive Andy Hornby told 
colleagues in a letter sent last week. 

This continues the trend of double 
digit growth reported in Alliance 
Boots' mid-year report in October, 
despite the weak global economy. 

Boots UK retail revenue growth in 
quarter three was "particularly 
pleasing", Mr Hornby noted, at over 
5 per cent. Dispensing volumes rose 
almost 4 per cent and customer 
compliments more than tripled, 

giving record customer care results. 

Alliance Boots' wholesaling 
division also showed "strong" 
growth, Mr Hornby said, which was 
"particularly good" in the UK, as well 
as Russia and Norway. 

The results put the group "well on 
track" to deliver 2009-10 targets, 
but Mr Hornby predicted 2010 
would be "another tough year". JR 

A greener future: Lloydspharmacy MD 
Richard Smith (right) joins shadow 
health secretary Andrew Lansley at the 
launch of the Conservative green paper 
on public health, which backed an 
expanded NHS role for pharmacists. 
The paper, A Healthier Nation, 
outlined plans to boost the sector's 
role in preventative care under a future 
contract. It praised pharmacists as the 
public's most frequent link to a 
"knowledgeable healthcare 
professional". The paper also outlined 
measures to tackle public health 
issues, such as obesity and drug use 
under a Conservative premiership. JC 



Virtual assistance 

The most dependable clinical and non-clinical information online 

Accurate and reliable information is critical when providing patient advice. 
That's why we've developed this fast, free and quality assured service to 
answer all your clinical and non-clinical questions. 

NHS Evidence gives you everything you need in one place, start your 
search today. 



NHS Evidence - Provided by NICE 


More news online 

The insight: generic substitution 

Angry patients and yet more extra work? Jennifer Richardson looks at the cost of the latest 
government plans to make pharmacists switch selected branded drugs for generics 

What's new? 

The Department of Health (DH) has 
launched a public consultation on 
plans to allow community 
pharmacists to dispense generic 
medicines against prescriptions for 
branded drugs. 

Why is this necessary? 
The DH estimates that 5 per cent 
of prescription items are brand- 
specific where there is a generic 
alternative, and believes closing 
this gap would save the NHS 
£41 million a year. 

Who does this affect? 
All practising community 
pharmacists, CPs and patients 
in England. 

What has the DH proposed? 
The consultation outlines three 
options for generic substitution: 

1. Do nothing (current situation 
remains; no generic substitution). 

2. Allow all branded products to be 
substituted with generics except 
those specified on an exempt list. 

3. Allow selected branded products 
specified on a list to be substituted 
with generics. 

Under the latter two options, 
there is the further variable of 
whether prescribers will be able to 
either opt out or opt in a prescription 
for generic substitution. 

What is the most likely outcome? 
The DH has expressed strong 
preference for the third option with 
an opt out clause. It believes this 
strikes the right balance between 

All smiles, but will patients be happy about pharmacists changing their medicines? 

patient safety, clinical needs, NHS 
costs and manageability of 

How will products suitable for 
substitution be selected? 
The DH has proposed an initial list 
of almost 40 products focused on 
those that will contribute most to 
savings, to be reviewed "on a regular 
basis". It says "only a few" new 
products will be added no more 
often than four times a year. 

How much is it going to cost 
the NHS? 

The DH has estimated one-off costs 

- including training pharmacy staff, 
and upgrading pharmacy computer 
systems, prescription forms and 
prescription pricing systems -of 
£3. 8m and has said it is "likely" to 
meet these costs itself. 

How much is it going to cost me? 
The DH has estimated the ongoing 
costs to pharmacies at £1.5m a 
year, mainly for the increased 
time demands of pharmacist 
intervention. It has not made clear 
who will pick up this bill - but 
expects the actual cost to 
pharmacies to be significantly lower 
due to savings in stock holding. 

When is this going to happen? 
The consultation was launched 
earlier this month, on January 5; it 
closes on March 30. Subject to the 
outcome, the DH says there will 
then be "a notice period" for 
implementation determined by the 
chosen option; no timescales are 
suggested other than that the 
chosen scheme will be implemented 
within the year. 

Should I be concerned? 
Pharmacist representatives have 
expressed concerns about: 

extra workload and responsibility 
for pharmacists 

the reaction of patients to a 
change in their regular medicines - 
PSNC has said this could cause 
"substantial difficulties" for 

whether generic substitution 
will achieve much when generic 
prescribing in the UK already stands 
at 83 per cent 

the need to exclude certain drugs, 
such as antipsychotics, for clinical 

The DH has said it has taken these 
factors into account in developing its 

Will it do any good? 

The DH has estimated net benefits 

to the NHS of between £73m and 

£237m, with a "best estimate" of 


What should I do now? 
Make your views on the proposals 
known. Respond to the consultation 

Mixed reaction greets government plans 

Pharmacists have mixed feelings 
about government plans for 
pharmacists to dispense generically 
against prescriptions for brands. 

Representatives approve of saving 
NHS cash, but are also concerned 
about the implications for those at 
the sharp end. 

There are many good reasons for 
generic substitution, says 
Pharmacists' Defence Association 
director John Murphy, and if 
healthcare professionals other than 
CPs are to be involved, "the 

pharmacist is more likely than 
others to have the skills and 
experience". But he adds: 
"Pharmacists must not assume that 
making substitutions is risk free." 

The PDA will be providing risk 
management guidance following the 
consultation, he says, "to ensure 
that pharmacists manage the 
necessary risks in the interests of 
patient safety and to ensure that 
they do not leave themselves open 
to claims". 

However, pharmacy law expert 

Noel Wardle does not expect too 
many liability issues, providing the 
product is substituted with a 
pharmaceutical equivalent. And he 
says a positive would be not having 
to chase GPs to get permission to 
substitute when a brand is out of 
stock. This burden will be replaced 
by another, though, Mr Wardle adds 
- the need to stay up to date with a 
regularly reviewed list of products 
for which generics can be used. 

The potential extra workload is an 
industry-wide concern. "Instead of 

solving the problem, which is doctor 
prescribing, they're trying to get 
round [that] by putting the burden 
on pharmacists, says Mr Wardle. "It 
would be better to get doctors 
prescribing properly." 

Find out what GPs 
think of the plans 




21 mg 



I CUck2Quit® Stop Smoking Plan 


NiQuitin Minis Mint 15mg/4mg Lozenges (nicotine). Indication: 

smoking cessation. Dosage: Adults (18 and over): One lozenge 
(max. 15/day) whenever urge to smoke to aid complete cessation 
(taper use after 6 weeks) or gradual cessation (seek advice if no 
reduction after 6 weeks) or gradual cessation (seek advice if no 
reduction after 6 weeks or no abrupt attempt after 6 months). 
Professional advice if use >9 months. Use 1 ,5mg strength if smoke 
i207day, otherwise 4mg. Adolescents (12-17 years): Abrupt 
cessation only. Dosing as for adults but seek professional advice if >1 2 
weeks treatment required/unable to quit abruptly. Contraindications: 
Hypersensitivity, non-smokers, children under 12 years. Precautions: 
Risk of NRT substantially outweighed by risks of continued smoking 
in virtually all circumstances. Supervise use in those hospitalised for 
Ml, severe dysrhythmia or CVA who are haemodynamically unstable. 
Once discharged, can use NiQuitin as normal. Susceptibility to 
angioedema, urticaria. Renal/hepatic impairment, hyperthyroidism, 
diabetes, phaeochromocytoma. Swallowed nicotine may exacerbate 
oesophagitis, gastric/peptic ulcer. Pregnancy/lactation: For those 
unable to quit unaided the risk of continued smoking is greater than 
the risk of using NRT. Start treatment as early as possible in pregnancy 
for 2-3 months. Lozenge/gum preferable to patches unless nauseous. 
Side effects: At recommended doses, NiQuitin Minis have not been 
found to cause any serious adverse effects. Nausea, hiccup, flatulence, 

Gl discomfort, vomiting, diarrhoea, dyspepsia, fatigue, malaise, chest 
pain, oral irritation, dizziness, headache, sleep disorders including 
abnormal dreams, anxiety, irritability, nervousness, depression, 
palpitations, increased heart rate, cough, sore throat, rash, anaphylaxis. 
See SPC for full details. Hjj] PL 00079/0610, 061 1 . PL holder 
GlaxoSmithKline Consumer Healthcare, Brentford, TW8 9GS, U.K. 
Pack sizes and RSP (excl. VAT): 20 s £4.75, 60 s £13.32 Date of 
revision: August 2009. 

NiQuitin 21, 14, 7mg Transdermal Patches, NiQuitin Clear 21, 14, 
7mg (nicotine). Opaque or transparent transdermal patches 21 mg, 
14mg, 7mg nicotine (Steps 1, 2, 3) for relief of nicotine withdrawal 
symptoms during smoking cessation. Dosage: Adults (18 and over): 

s10 cigarettes/day, Step 1 for 6 weeks, then Step 2 for 2 weeks, then 
Step 3 for 2 weeks.<1 cigarettes/clay, Step 2 for 6 weeks then Step 3 
for 2 weeks. Apply to fresh site (clean, dry skin) once dairy. Professional 
advice if use >9 months. Adolescents (12-17 years): As for adults 
but to seek professional advice if >12 weeks treatment required. 
Contraindications: Hypersensitivity, occasional/non-smokers, children 
under 12 years. Precautions: Risk of NRT substantially outweighed 
by risks of continued smoking in virtually all circumstances. Supervise 
use in those hospitalised for Ml, severe dysrhythmia or CVA who are 
haemodynamically unstable. Once discharged, can use NiQuitin as normal. 
Susceptibility to angioedema. urticaria. Discontinue use if severe/persistent 

skin reactions. Renal/hepatic impairment, hyperthyroidism, diabetes, 
phaeochromocytoma. Pregnancy/lactation: For those unable to quit 
unaided the risk of continued smoking is greater than the risk of using NRT. 
Start treatment as early as possible in pregnancy for 2-3 months. Lozenge/ 
gum preferable to patches unless nauseous. Remove patches at bee time. 
Side effects At recommended doses, NiQuitin patches have not been 
found to cause any serious adverse effects. Local rash, itching, burning, 
tingling, numbness, swelling, pain, urticaria, heaviness, hypersensitivity 
reactions. Headache, dizziness, tremor, sleep disorders, nervousness, 
palpitations, tachycardia, dyspnoea, pharyngitis, cough, Gl disturbance, 
sweating, arthralgia, myalgia, malaise, anaphylaxis. See SPC for full details. 
§SL) PL 00079/0368, 0367, 0366, 0356, 0355 & 0354. PL holder: 
GlaxoSmithKline Consumer Healthcare, Brentford, TW8 9GS, U.K. Pack 
sizes and RSP (excl. VAT): 7 patches £14.89; Step 1 only 14 patches 
£28.04. Date of revision: August 2009 NiQuitin* NiQuitin Minis 
and the Minis Device are trademarks of the GlaxoSmithKline group 
of companies. 

Reference: 1. National Institute Clinical Excellence. Smoking 
cessation services in primary care, pharmacies, local authorities 
and work places, particularly for manual working groups, pregnant 
women and hard to reach communities. Public Health Guidance 10. 

The Online Pharmacy Comn 

r patch 

Dendron launches Freederm wash 

Dendron is introducing a new face 
wash for sensitive skin into UK 

Freederm Sensitive Facial Wash is 
a gentle foaming wash for sensitive 
skin that is prone to spots. 

Developed and marketed by 
Diomed Developments, the product 
is formulated to penetrate the pores 
to thoroughly cleanse the skin and 
excess oil. 
It is 

suitable for 
daily use. 

range also 

Exfoliating Facial Wash, Facial 
Cleanser, Zone Balancing Moisturiser 
and Treatment Gel to help get rid of 
inflamed red spots and help stop 
new ones forming. 

Price and Pip code: £5.99/150ml, 



Tel: 01923 229251 

Market focus 

• The total medicated skincare 
category is worth £85 million 
and Freederm accounts for 
4 per cent of the market (IRI 
Infoscan value sales all outlets, 
MAT August 2009) 

• Freederm Treatment 
Gel is the best-selling 
pharmacy OTC spot 
treatment (IRI Infoscan 
value share chemists, 
including Boots and 
Superdrug, MAT August 

Promensil is new name for Novogen Redclover 

Novogen Redclover has 
been renamed Promensil. 
The name change is 
designed to bring the 
menopause product into 
line with Novogen's global 
business and to clearly 
differentiate the 
product from generic red 
clover products. 

The product's 
formulation, which 
contains red clover 
isoflavones, remains 





Red Clover Isoflavones 

unchanged and 
the packaging will 
continue to 
feature the red 
clover flower. 

In addition, 
Promensil is 
available in a new 
double strength 
format containing 
twice the level of 

Novogen is 

Disney appeal for NUK babies 


case for aspirin 

DE Pharmaceuticals will launch a 
portable aspirin container into 
independent pharmacies on 
February 1 . The Aspod is designed to 
provide customers at risk of a heart 
attack with instant access to a one- 
off dose of emergency aspirin. 

The green scratch resistant case 
can hold two aspirin tablets (not 
supplied) and can be fastened onto, 
or act as, a key ring. It can also be 
hung from a belt loop, handbag or 
rucksack by using the metal belt 
clip supplied. 

Peter Elwood, honorary professor 
at Cardiff University department of 
primary care and public health, 
comments: "Patients known to be at 
risk of a heart attack, including all 
persons over about 50 years of age, 
would be well advised to carry a few 
tablets of soluble aspirin at all times, 
and chew and swallow a tablet 
immediately if they experience 
severe chest pain, even as they are 
phoning 999." 

Price £5.99 

DE Pharmaceuticals 

Tel: 0800 072 0626 

Retail talk 

Do you feel 
optimistic about your 
retail sales in 2010? 

Yes 18% 


No 82% 

Off the shelf view: 

It's not a very rosy picture for the 

year ahead, as most voters take a 

pessimistic view of the outlook for 

pharmacy retail sales. 

This week's question: 

Did the 'big freeze' affect your 

product sales? 

Vote at www.chemistand 

The NUK baby feeding range has 
been awarded the licence for 
Disney's Mickey and Minnie 
characters and a new range of 
Disney baby products will be 
launched in February. 

The Disney Collection will 
feature the NUK First Choice feeding 
bottle and learner bottle with 
Mickey and Minnie as they appeared 
more than 80 years ago in a red, 

Cosmetique Active is adding an ultra 
corrective foundation cream stick to 
its Vichy Dermablend range. 

Dermablend Cosmetique 
Corrective is designed to correct 
moderate to severe complexion 
flaws including age/sun spots, 
pregnancy mask, rosacea, marked 
dark circles, acne, vitiligo, angioma 
and post-operative lesions. 

It is formulated to provide double 

white and black design. 

It will also include Mickey 
orthodontic soothers in size 1 (0-6 
months) and size 2 (6-18 months). 

The range is BPA free, in line with 
the rest of the NUK baby care range. 

Price: £5.99/300ml bottle, £5.79/ 
learner bottle, £3.90/soothers 
MAPA Spontex 
Tel: 01905 450300 

the coverage of a classical 
foundation without a mask effect. 
The manufacturer says it is resistant 
to perspiration, bathing and rubbing. 

The hypoallergenic SPF30 stick 
comes in seven shades. 

Price £11.26/12g 

Pip codes: see 

Cosmetique Active UK 

Tel: 020 8762 4030 

supporting the brand with a 
£500,000 campaign over the next 
nine months, targeting GPs, nurses 
and hospital specialists as well as 
consumers and retailers. In-store 
activities are planned and point of 
sale material will be available. 

Price and Pip code: Promensil 
£19.99/30, 254-6414; £41.99/90, 
280-5380; Promensil Double 
Strength £24.99/30, 348-9291 

Tel: 01753 833321 

Natural Being 
skincare in UK 

A natural skincare line from 
New Zealand is being launched 
in the UK. 

Natural Being is a range of nine 
skincare products based on New 
Zealand's Manuka honey and 
Manuka oil. 

The range comprises cleanser, day 
cream and night cream for oily to 
normal skin or normal to dry skin. It 
also includes toning gel, eye cream 
and body cream for all skin types. 

Manuka honey is claimed to 
revitalise skin by stimulating cell 
renewal and to maintain moisture 
levels without feeling greasy. The oil 
is chosen for its antibacterial, anti- 
fungal and anti-inflammatory 

Price: From £4.99/1 00ml cleanser 
to £8.50/50ml night cream 
Nature's Infinite Balance 
Tel: 0845 250 8460 

Vichy offers corrective stick 


Check what's on TV this week 


Iced comfort for morning sickness 

flavoured ice pops 
designed to help 
alleviate the 
symptoms of 
morning sickness 
will be launched 
into independent 
pharmacies on 
January 26. 

Lillipops Iced 
Soothies were developed 
by a mother to ease her nausea 
when she was pregnant with 
her third baby. 

Lillipops says the product has also 

post-operative comfort. 

The ice pops come in five flavours: 
grapefruit & tangerine, lemon & 
mint, camomile & orange, lime & 
vanilla and ginger. 

Available in an assorted multipack 
of all five favours, they contain no 
artificial colours or sweeteners. 
Customers should keep them in 
the freezer. 

been used to help alleviate nausea 
and an inability to keep down fluids 
caused by various medical 
conditions including chemotherapy, 
diabetes, stomach upset and as a 

Price and Pip code: £6.95/20, 



Tel: 01923 804182 

P&G reveals Oral-B Pro-Expert range 

Procter & Gamble is consolidating 
its Oral-B CrossAction Complete and 
Pulsar manual toothbrushes under a 
new range on February 1. 

The Oral-B Pro-Expert range will 
feature four CrossAction brushes - 
Professional, GumCare, Superior 
Clean and Enamel Protection - 
that are designed with crisscross 
bristles in opposing directions to 

lift and sweep away plaque. 

The range will include two Pulsar 
brushes - Professional and GumCare 
- with MicroPulse bristles that pivot 
to penetrate deep between teeth 
and clean along the gum line. 

New packaging is designed to 
make it easier for consumers to 
choose the right brush. 

P&G says the range is designed to 

communicate the end-benefits of 
its premium manual brushes to 
loyal manual toothbrush users, as 
well as to encourage new users into 
the category. 

Price: CrossAction £3.99; Pulsar 

Procter & Gamble 
Tel: 0800 7311792 

Fitvits charity link 

The Fitvits children's vitamin 
brand which was launched on 
January 10 (C+D, November 21, 
2009, p12) has linked up with the 
new UK charity KidsAid, which 
helps children who have suffered 
from traumatic events. The 
charity will receive lOp from 
every month course of Fitvits 
Multivitamin gummy bears and 
Omega 3 gummy sharks and 5p 
from every week's trial course 
DTP (Europe) 
Tel: 0115 924 8160 


We gave an incorrect phone 
number for Tyrrell Healthcare in 
the ThyroScreen Professional 
thyroid test kit story last week 
(C+D, January 16, p13).The 
company can be contacted on 
01273 494401 or emailed at 

From minor oyo infections 

to acute bacterial conjunctivitis 

Relief is golden. ..with 


.0.5% W/v 

lietonate l S% w/vj 

a Propamidine tetionate 
0. \%. w/v 

Chloramphenicol I 09*, jjI-n 

For your eye-catching Golden Eye POS or 
to find out more, contact your Dendron rep 
or call 01923 229251 

Antibiotic & Non-Antibiotic Ointments 

Antibiotic & Non-Antibiotic Drops 

Golden Eye Antibiotic 1% w/w Chloramphenicol Eye Ointment Marketing Authorisation held by: Martindale Pharmaceuticals Ltd . Bampton Road. Romford. RM3 8UG Golden 
Eye Antibiotic 0.5% w/v Chloramphenicol Eye Drops Marketing Authorisation held by: Tubilux Pharma SpA. Via Costarica, 20/22 - 00040 Pomezia, Rome, Italy Distributed by: 
Typharm Ltd.. 14D Wendover Road, Rackheath Industrial Estate, Norwich. NR13 6LH Indications For the topical treatment of acute bacterial conjunctivitis Golden Eye 0.1% w/v Eye 
Drops Solution and Golden Eye 0.15% w/w Eye Ointment Marketing Authorisation held by: Typharm Limited, 14DWendover Road, Rackheath Industrial Estate, Norwich, NR13 6LH. 
Indications: For the treatment of minor eye or eyelid infections, such as conjunctivitis and blepharitis Legal Category: B Further prescribing information is available from Typharm Ltd, 
at the address above. 


Relief is Golden 


What do you think? 


Weblnar or webinaren't? You decide 


At a meeting yesterday there was a pause in the 
conversation, and so I said: "I attended my first 
webinar this week!", only to be met with a 
bemused silence. The younger ones in the group 
looked up briefly from updating MyFace on their 
ePhones, while the older ones looked quizzically 
and then returned the conversation to whether 
Monty Panesar will get back in the England team. 
That's the thing with IT - it's not sexy. 

Eventually someone prompted me to say more, 
so I went on to explain that RPSCB events now 
include web-based seminars, or 'webinars', as part 
of the new learning experience promised by the 
PLB and its 22 New Year resolutions. I related how 
you had just the same PowerPoint presentation 
slideshow - with audio so that you could hear the 
expert speaker - and the same Q&A opportunities 
as any other learning event, but all from the 
comfort of your own home. 

No struggling through snow or the rush-hour 
traffic at the end of a long day (think of all that 
C0 2 saved), no standing room only if a popular 
topic is busy and, best of all, you're not forced to 
drink stewed coffee and eat the deep-fried animal 
entrails favoured by the more affordable training 
venues. Just 90 minutes in a comfy chair in front of 
your PC, then 10 minutes on the CPD website and 
"Bingo!" another CPD entry in the bag - only eight 
more to go. 

But is this really "the future of educational 
events", as one enthusiastic delegate suggested? 
Why stop there? We could use Twitter, and instead 
of nine CPD entries a year we could opt for five 
'Tweets' a week - each one 140 characters of 
condensed learning, like an InfoPOEM in txt. Cod 
forbid! After all, ask any branch secretary or CPPE 
tutor what people most appreciate, and it's the 
interaction, the contact with our peers that we 
crave after a day in the dispensary discussing 
Hollyoaks with Stacey, or hearing about 
Margaret's hot flushes. So while I'm not part of the 
21 per cent who think the 1860s was the best 
decade to be a pharmacist, the PLB's promise of a 
'Virtual Local Practice Forum' fills me with dread. 

But then there was a slightly awkward silence as 
we all searched for something to say next since, as 
pharmacists, we're not great at small talk. I 
debated asking if anyone had seen Hollyoaks this 
week, but someone started a discussion about the 
latest patient pack debate. Ah yes - to snip or not 
to snip. Now we were on familiar ground and the 
conversation flowed. 

Maybe that delegate was right, and webinars 
are the way forward because they do away with 
the need for conversation. Better still - come EPS 
and remote supervision - some of us might never 
have to interact with a human being again. Who 
said there were no advantages to new technology! 

Casting a legal eye over 2009 

What a year 2009 was! The MHRA 
issued guidance trying to stop 
exporting. The NHS Counter Fraud 
Service began investigating specials. 
The Medicines Act was amended to 
bring in a requirement for responsible 
pharmacists. The National Health 
Service Act was amended to 
introduce as from this year a new 
control of entry test. But the most 
prominent legal issues faced by 
pharmacists in 2009 were in the 
criminal courts. 

First there was the Elizabeth Lee 
case. You will recall that after a 
dispensing error, Mrs Lee, a locum, 
pleaded guilty to a labelling offence 
under the Medicines Act, and an 
Old Bailey judge imposed a three- 
month prison sentence that he 
suspended. In the furore that 
followed, it was heartening to read in 
C+D towards the end of the year 
that, following the suggestion I made 
in myjune column, the Crown 
Prosecution Service will publish 
guidelines about whether and when 

to prosecute pharmacists. 

Just when you might have felt it 
was safe to go back into the 
dispensary, Prestatyn Magistrates 
waded in. A patient brought a 
prescription for spironolactone to a 
pharmacy, but was given sertraline 
by mistake. The pharmacist and a 
dispenser were convicted of 
supplying the wrong medicine in 
breach of section 64 of the 
Medicines Act. The dispenser's 
appeal to the High Court was 
dismissed, and a transcript of the 
court's reasons finally became 
available in December. 

The dispenser's barrister argued 
that the offence under section 64 
could only be committed by a 
company that owned a pharmacy 
owner or a pharmacist. He drew 
attention to some sections of the 
Medicines Act that impose 
obligations on persons who act in the 
course of a business that they are 
carrying on. Mr Justice Elias politely 
described this as "a bold submission" 

that involved asking the court to 
pretend that section 64 included 
words that were not there. The judge 
said there was "an obvious public 
interest in ensuring that all those 
whose failings have led to the 
[supplying] wrongly, of a product in 
this way, should be held accountable". 
The judge went on to say that the 
decision was not harsh and just 
because the pharmacist failed to 
carry out her obligations, the 
dispenser who had selected the wrong 
product was also guilty of an offence. 

Section 85 of the Medicines Act 
also creates an offence, but only by a 
person who is acting in the course of 
a business carried on by him. What 
does section 85 deal with? Labelling. 
According to the law, the Prestatyn 
dispenser was guilty of an offence 
under section 64, but the High Court 
ruling raises the question whether 
Elizabeth Lee was wrongly convicted. 
David Reissner is head of 
healthcare at Charles Russell LLP, 
where he is a partner 





Update: Your guide ^ 
to stoma care 

Part two: choosing the 
right appliance and 
dealing with lifestyle 

Practical Approach 

medicines for coughs 
and colds - what's the 


Help your customers 
navigate this complex 
category and grab a 
share of a £1 9m sector 

How to handle your 
rent review 

Expert tips on 
maximising your 
negotiating power 

C+D Awards 

Phlebotomy training 
gave 2009's Pharmacy 
Assistant of the Year 
Sally Ingram the edge 


With the recent bad 
weather in mind, 
where do employees 
stand if they can't get 
to work? 

I * * 

4 relief MR 

js> tamsulosin 


Benign prostatic hyperplasia (BPH) is a common condition, 
with around 1 in 4 men above the age of 40 experiencing some 

The alpha-blocker tamsulosin 0.4mg is the UK's most widely 
prescribed drug for treating BPH', and it is now available for you 
to recommend over the counter as Flomax Relief. 

The prostate is a small gland located in the pelvis. It surrounds 
the urethra, which is the tube through which urine is voided from 
the bladder. If the prostate becomes enlarged, it puts pressure 
on the bladder and urethra. This can cause lower urinary tract 
symptoms (LUTS), which typically present as: 
difficulty starting urination 
a frequent need to urinate 
difficulty emptying the bladder fully. 
In some men, the symptoms are mild and do not need 
treatment. However, if symptoms are more severe, they can 
restrict sporting or social activities (need to be near a toilet) and 
disturb sleeping patterns. BPH can be managed by: 
Lifestyle advice: 
Avoid drinking large amounts of liquid - but remain hydrated 
Avoid drinks before going to bed 
Cut back on drinks containing alcohol and caffeine. 
Medical treatment: 
Alpha blockers such as tamsulosin are a first choice treatment 
for men with smaller prostates and moderate LUTS 2 . They 
work by relaxing the smooth muscle in the prostate and neck 
of the bladder, thereby allowing an increased maximum 
urinary flow rate and providing symptom relief. 

Recommend Flomax Relief for men aged 45-75 
with lower urinary tract symptoms caused by BPH. 
Proven, clinically effective and once a day... 


relief MR 

For more information, visit 


1 Department of Health Prescription Cost Analysis Data England 2004 p214wwwdhgovuk 

2. Speakman MJ, Kukby RS, Joyce A, Abrams P Pocock R Lower Urinary Tract Guideline for the primary care management of male 
lower urinary tract symptoms BJU International 2004, 93 985-990. 

Flomax Relief® MR. Presentation: Contains 0.4mg of tamsulosin hydrochloride in a modified 
release capsule. Indication: Treatment of functional symptoms of benign prostatic hyperplasia 
(BPH). Dosage: For men aged 45-75 years. For oral use. One capsule daily. Legal Category: P 
PL Number: PL 00015/0280. Further information available from: Boehringer Ingelheim Limited. 
Consumer Healthcare, Ellesfield Avenue, Bracknell, Berkshire RG1 2 8YS. 15 


Sign up for Update 2010 before January 31 and save £5 

Your weekly CPD revision guide 

Module 1510 

Your guide to stoma care 

The second of two articles is about choosing the right appliance 
and dealing with lifestyle issues 

Need CPD resources? Check our 
massive clinical index 

60-second %y 

Could you carry out an 
appliance use review? 

This article describing stoma appliances 
and how to resolve problems from 
patients could form part of your CPD in 
preparation for involvement in the new 
advanced services, appliance 
customisation and appliance use review. 

Which appliance? 

The choice depends on the type of stoma 
and effluent, patient lifestyle, dexterity, 
stoma visibility and skin sensitivity. 

Is a special diet needed? 

The advice is to eat a healthy varied diet 
but to maintain a high fluid intake. Peop 
with colostomies and urostomies should 
avoid constipation, while those with an 
ileostomy should avoid high fibre foods. 

This article (Module 1510) can help in the 
following CPD competencies: Gla, Gld, Of, 
C3h. See 

Julia Williams 

Supported by 


Most people who have undergone stoma surgery 
adapt well, but others find their stoma is a source 
of great anxiety that causes significant 
psychological difficulties. Their physical and 
psychological needs can be dealt with, and their 
goals, capabilities and resources can be used to 
help them make the change from being stoma 
patients to individuals engaging in their normal 
lifestyle, and who happen to have a stoma. 

Careful preparation and assessment can identify 
potential risks and needs so that care can be 
planned, and encouraging patients to lead a full 
and active life will often ease their adaptation. 

A secure, comfortable and discreet appliance 
plays an important part in this rehabilitation. 1,2 
The more confident patients feel about the 
practicalities of stoma management, the sooner 
they can return to their daily activities. 

A wide variety of appliances is available, but the 
presence of a stoma complication may restrict 
choice. The incidence of these complications is 
difficult to quantify, 3 but the main causes appear 
to be general stoma management and stoma 
position, 4 so careful siting is essential. 

Most complications occur within the first 12 
months following surgery. 5 These include skin 
excoriation, retraction, mucoseparation, 
parastomal hernia, prolapse, stenosis, appliance 
leakage, constipation and diarrhoea. 6 Surgical 
modification may be necessary and occasionally 
patients may have their stoma relocated. 

New patients are taught to manage their stoma 
independently so that when they go home they 
will only require minimal support. 7 

Which appliance? 

The nature of the effluent will determine which 
appliance is used - whether it is closed, drainable 
or tapped. A thorough assessment is important as 
the patient's preference and ability to manage the 
stoma will determine which appliance is 
appropriate. The following should be considered: 
■ the type of stoma and its position 

the effluent being passed 

the patient's lifestyle, manual dexterity and 
visibility of the stoma 
• any skin sensitivities 

the patient's preference regarding the 
appliance's ease of use, appeal, comfort, reliability 
and availability. 

There are four main categories: one-piece, two- 
piece, clear and opaque. 

One-piece appliance 

As the name suggests, the one-piece appliance 
incorporates the bag and adhesive base plate 
together. The adhesive base will have either a 
hydrocolloid skin barrier or a hypo-allergenic 
adhesive, or both. The hydrocolloid component 
acts as a skin protective barrier and the adhesive 
provides additional security. 8 

If the stoma is irregular in shape it is appropriate 
to use an appliance with a cut-to-fit opening. This 
enables a template of the stoma size to be used as 
a guide to make an accurate aperture. When the 
stoma is regular in shape, a pre-cut opening is 
available to fit securely around the stoma, 
although the correct size must be ascertained: if 
the aperture is too large the skin may become 
excoriated, but if too small the aperture may 
constrict the stoma and in severe cases can lead 
to ischaemia. 9 

One-piece appliances are considered the easiest 
to apply and remove, and are soft, flexible and 
discreet under clothing. They are suitable for 
patients with reduced manual dexterity or for new 
patients as fewer learning stages are required; 2 
they are available in closed, drainable or tapped 
(urostomy) forms, and in clear or opaque options. 

Iwo-piece appliance 

The two-piece system has a base plate (flange) 
and appliance. The skin barrier to the base plate 
has properties similar to the one-piece and is 
available with or without the hypo-allergenic 
adhesive. Generally, the base plate is cut to size at 
each appliance change; a cutting guide may be 
required. It is possible to arrange for dispensing 
appliance contractors (DACs) to cut the base 
plates if a guide to the actual stoma size is 
supplied. Cutting devices are also available that 
punch out a hole in the base plate to the exact 
size of the stoma. 

Once the base plate is in place over the stoma, 
the appliance is clipped or stuck onto the base 
plate. This enables the appliance to be renewed 
regularly while the base plate remains in place. 
Usually the base plate is renewed once or twice a 
week and the appliance renewed as required. 

The advantage of this arrangement is that the 
appliance can be changed without disturbing the 
surrounding peristomal skin, which reduces skin 
irritation. 10 In addition, smaller appliances can be 
interchanged during times when a discreet 
appliance is more important than capacity, eg 
during swimming, other sports and sexual 
intercourse. Two-piece appliances are available in 


23.01.10 CPD 

closed, drainable or tapped (urostomy) forms and 
may be clear or opaque. 

Clear and opaque appliances 

Clear appliances allow the stoma and effluent to 
be easily observed, which is particularly important 
for patients whose stoma is new. 

Some patients prefer to continue with a clear 
appliance as they can see the stoma when placing 
the appliance on the abdomen, which increases 
their confidence that the appliance is secure, but 
opaque appliances are used by many who prefer to 
disguise the effluent. Opaque appliances generally 
have a soft material outer cover to ensure comfort 
against the skin. 

Some clear appliances have a split soft outer 
covering so that the stoma can still be easily 
observed while concealing the effluent. 

Leakage and odour 

Disposable stoma care products are made from 
odour-proof laminated plastic and include a filter 
that allows gas to escape, preventing the appliance 
ballooning under clothes. Many also incorporate a 
deodorant to prevent odour becoming a problem. 

Where it arises, odour may indicate a leak, 
perhaps because the bag is full and should be 
changed. Leakage may also occur if the stoma is 
below skin level or retracted, and when there is not 
enough support to give a good seal. Products are 
available with a convex base that fills this gap. 

Appliance disposal 

Used appliances can be wrapped securely in a 
plastic bag and discarded as domestic waste. 
Delivery services supply disposable bags, but 
nappy sacs or old carrier bags can be used. 
Ileostomy Drainable appliances should be 
emptied into the toilet and rinsed through. It is 
not necessary to clean the appliance thoroughly. 
The used appliance should then be wrapped 
securely in a plastic bag and placed in the 
domestic waste. 

Colostomy Closed appliances should be cut at 
the bottom and the contents shaken down the 
toilet and flushed. 

Stoma appliances are generally not biodegradable 
and cannot be flushed into the sewage system. 
However, a flushable appliance is now available 
for colostomy stomas in which waste material 
passes into an inner liner inside a protective 
pouch; after removal, the inner liner is flushed 
down the toilet and naturally dissolves in the 
sewage system. 

Urostomy Tapped appliances should be emptied 
into the toilet and rinsed-through. The used 
appliance should then be wrapped securely in a 
plastic bag and placed in the domestic waste. 

A key goal of stoma care is to maintain the 
integrity of the peristomal skin. Stoma care is 
generally best kept as simple as possible, and 
many ostomists self-care successfully using few or 
no accessories. However, problems with 
established stomas may become more evident in 
the long term, generally because ostomists 
Frequently adapt their new lifestyle to 
accommodate the stoma. 11 Most of these 
oroblems can be managed with the use of 

Modern appliances often reduce skin trauma 
and sensitivity, but tightening financial constraints 
mean that patients must be assessed to ensure 
they need the accessories. Assessment should 
include the condition of the peristomal skin and its 
sensitivity, the type of effluent and the patient's 
ability. 12 Expenditure on accessories and aids for 
stoma appliances in England alone is more than 
£1 million per annum. 8 

Some accessories and their use 

The accessories available on an NHS prescription 

deodorants - to assist with elimination of odours 
pastes - to fill creases and dips around the stoma 

• powders - to protect sore excoriated 
peristomal skin 

skin barriers and protective wafers - to protect 
the peristomal skin from effluent or contact 

seals and washers - to fill stoma creases and dips 
night drainage - used to increase the capacity of 
the appliance, particularly for the urostomist 
adhesive removers 

absorbing agents - used to transform a liquid 
stool into a more manageable solid stool 

retention strips - provide additional security 

stoma caps - these are small minipouches for 
use with colostomy irrigation or short periods 

belts - additional support to increase security; 
'sash' belts are used to support parastomal hernia 

abdominal supports - for parastomal hernia 

• activity shields (St Mark's shields) - these are 
used in contact sports to protect the stoma and in 
the management of prolapsed stoma. 

Dietary needs 

Each person will need individual assessment, but 
the general advice should be to eat a healthy 
varied diet. 

Following abdominal surgery it is important to 
re-introduce food cautiously. The time frame varies 
for each patient, frequently following a gradual 
increase in intake from the day after surgery. 
Colostomists should try to avoid constipation and 
drink about 1.5 to 2 litres daily. For an ileostomist 
the general advice may be: 

chew food well to reduce the risk of obstruction 
take high fibre foods with caution 
drink about 1 .5 to 2 litres of liquids daily 
ensure adequate salt intake (particularly if 
stools are loose and during hot weather) 

some foods including carbohydrates will thicken 
a loose output. 

Specific advice to people with urostomies: 
drink about three litres of liquids daily 
drink cranberry juice to reduce mucous 


take drinks high in vitamin C, which acidifies 
urine, reducing mineral deposits. If high doses are 
needed, supplements may be used 

avoid constipation, which can contribute to 

bacterial infections causing the rare purple urine 
bag syndrome. 

Problem foods 

As with the general population, ostomists may 
find that certain foods increase wind production, 
eg beans, beer and other alcohol, carbonated 
drinks, cabbage, cauliflower, broccoli, sprouts, 
eggs and chewing gum. Drinking peppermint tea 
or peppermint oil in hot water may help, as may 
eating fennel. 

Other foods increase the odour of stools, eg 
broccoli, sprouts, eggs, fish, garlic, onions, some 
cheeses and some vitamins, but this should not be 
noticeable if the pouch is intact. Foods that may 
help reduce odour are parsley, cranberry juice, 
yogurt and buttermilk. 

Red foods such as beetroot, strawberries and 
tomato sauce may give the appearance of bleeding. 


Special care is needed with some medications: 
Constipation and diarrhoea The first step is to 
review the diet. If medicines are needed, patients 
should seek advice from the CP or stoma care 
nurse about which medicines are most 
appropriate. After that, these products can be 
bought OTC. Rehydration solutions and 
antidiarrhoeals can be used, and ileostomists 
should increase their salt intake during episodes of 
diarrhoea. For constipation, oral laxatives and 
suppositories may be used only by colostomists. 
Indigestion Ostomists may be more susceptible 
to diarrhoea due to taking magnesium salts, and 
to constipation caused by aluminium salts. 
Pain relief Opioids may cause constipation 
ostomists, and anti-inflammatories may cause 
gastric irritation and bleeding. Paracetamol is 
suitable for these patients, however. 
Iron preparations may cause diarrhoea and 
sore skin. 

Diuretics should be used with care in people with 
an ileostomy as they may become dehydrated. 
Enteric-coated and modified release 
preparations are unsuitable for ileostomists, as 
there may be insufficient release of the active drug. 

A table summarising common problems and 
their management, together with other questions 
about lifestyle, are in the full version of this article 

Julia Williams, MEd, BSc (Hons), Dip D/N, 
RCN, is senior lecturer in gastrointestinal 
nursing at The Burdett Institute of 
Gastrointestinal Nursing in partnership 
with Kings College London and St Mark's 
Hospital, Harrow. 

Download a CPD log sheet that helps you 
complete your CPD entry when you 
successfully complete the 5 Minute Test for 
this Update article online (see pi 8). 


Update discusses how and when 
hypnotics should be used for 
treating insomnia 17 


Sign up for C+D's free clinical newsletters at 

Your guide to stoma care: part 2 

What stoma appliances are available for ostomists? 
What are the pros and cons of two-piece appliances? 
Why should urostomists avoid constipation? 

This article describes the stoma appliances and 
accessories available, with advice on skincare, diet, 
medication and other questions ostomists might ask. 

Read the full version of this article, with more about 
managing stoma problems, at 

Find out more about ostomy pouches and other 
appliances from the C3 Life website at 

Read the advice for patients on the C3 Life site about 
skincare and diet, at and at 

Find out about changing pouches, clothing and travel 
advice, and problems such as odour and leakage from 
the Colostomy Association website at http://tinyurl. 
com/yzyadnw and 

Read the BNF section 1.8 Stoma care for information 
about prescribing for ostomists. 

Think how you could improve the service you offer 
your ostomy clients, eg by offering the proposed 
appliance use reviews. 

Are you now familiar with the appliances that ostomists 
use? Could you give advice about the accessories and 
common problems with foods and medication? 

5 minute test 
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Step 1 

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Step 2 

Access the 5 Minute Test questions on the C+D website at 

Step 3 

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recorded. If you successfully complete the 5 Minute Test online, you will 
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entry at 

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Sign up before January 31 and save £5. 

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Get a CPD log sheet for your portfolio when you successfully complete 
the 5 Minute Test online. 

Practical Approach 

pharmacy scenario 

Complementary remedies for colds? 

It is the height of the cough and cold 
season at the Update Pharmacy. 
Pharmacist David Spencer has 
assigned Manu, the pre-registration 
trainee, to work on the medicines 
counter for a fortnight, with the 
specific brief to audit requests from 
customers for information on 
complementary medicines for 
prevention and treatment of upper 
respiratory tract infections (URTI). 
He will then research evidence and 
compile a report on their 

"How did it go?" David asks Manu 
at the end of his stint. 

"It was very interesting. Some 

people asked what I thought of their 
traditional family remedies." 

"Like what?" asks David. 

"Cooking with extra garlic and 
dosing everyone with chicken soup as 
soon as the first person in the family 
shows signs of a cold. Or not drinking 
milk or eating cold foods to reduce 
the risk of catching a cold." 

"And what about complementary 

"Plenty of enquiries about those 
too, particularly vitamin C, zinc, 
echinacea and garlic. They'll all be in 
my report, plus the evidence of 
effectiveness that I've found," replies 


What is the expert opinion on and 
evidence for the effectiveness of 
the therapies Manu mentioned? 


Family remedies and practices 

Whether these are effective 
prophylactic or therapeutic agents, 
or just make patients feel better, 
they are generally safe and support 
cultural identity and self-efficacy. 
Patients should not be dissuaded 
from them by healthcare providers. 1 

Vitamin C A Cochrane systematic 
review concluded prophylactic 
vitamin C supplementation is not 
effective in reducing the incidence of 
URTI in most adults, but in a 
subgroup of healthy adults engaged 
in highly physically stressful 
activities (marathon runners, skiers, 
and soldiers on subarctic exercises), 
taking vitamin C reduced incidence 
by 50 per cent. Prophylactic vitamin 
C supplementation also reduced 
duration of URTI symptoms by a 
small but consistent amount (adults, 
8 per cent; children, 14 per cent). 
But taking vitamin C after symptoms 
had begun produced no overall 
benefit on their severity or duration. 2 
Zinc Results of studies of the 
effectiveness of zinc supplements in 
preventing or treating URTIs have 
been mixed. But overall, zinc 
supplementation in healthy, well 
nourished populations does not 
appear to reduce the risk. Data on 
the effectiveness of lozenges in 
reducing the duration and severity of 
established URTIs have been mixed. 3 
Echinacea Research generally 
supports the use of high quality 
Echinacea purpurea products by 
adults to prevent or treat URTI. A 

2007 meta-analysis of 14 controlled 
trials in adults concluded that E 
purpurea taken prophylactically 
decreased the odds of the common 
cold developing by 58 per cent and 
decreased the duration of a cold by 
1.4 days. 4 

Garlic A Cochrane review reported 
one high-quality trial that found that 
a daily garlic supplement (180mg 
allicin content) for 12 weeks 
significantly reduced the incidence 
of the common cold. But there is no 
information from randomised 
controlled trials about whether 
taking garlic at the time of a cold 
reduces either symptom severity or 
the number of days' illness. 5 
References are at www.chemistand 

This article can help with these 
CPD competencies: da, Clc, C1d, 
G2o, Clf. 


To see the full archive of Practical 
Approach articles go to 
/practical approach 




Total footcare 
market value 


Decline in 
footcare market 



value share of 
the footcare 


Decline in 
value share of 
footcare market 

Source: IRI value sales 52 
weeks to November 28, 2009 



The footcare market is complicated, but 
pharmacists can help customers navigate the 
category and maximise sales as a result, find 
Jennifer Richardson and Zoe Smeaton 

Footcare is a complex and cluttered 
market," notes Jane Draude, spokesperson 
for leading pharmacy brand Care, and this 
is certainly reflected in the mixed messages 
coming from the available data on the category. 
Market value and growth figures for footcare vary 
widely, depending on the source and the 
subcategories included in the numbers. 

A Market Insight for C+D by data analyst IRI 
(above right) puts footcare at £19 million and 
declining markedly, by almost 12 per cent. 
However, footcare brands are more likely to quote 
around £120m and continued low growth of 
around 3 per cent. The latter probably reflects a 

wider range of treatment subcategories included 
alongside foot skincare, which footcare brand CCS 
puts at the £19m mark. 

But what everyone does agree on is that 
pharmacies are the first port of call for sufferers 
of foot complaints and they can capitalise on this 
by improving their product and service offering in 
this category. 

Lloydspharmacy pharmacist Nitin Makadia 
agrees that footcare is an "important" category 
for the multiple and says it doesn't appear to have 
been affected by the economic climate. She 
suggests that athlete's foot, corn, callous, bunion 
and verucca treatments make up nearly half of 

Market Insight 

Unlike the winter remedies category, which 
benefits from a strong winter season, footcare 
tends to flourish in the summer. A relatively 
poor summer in 2009 has meant that footcare 
is down by 3 per cent in the latest year. 

The nailcare subcategory is showing the 
strongest decline, with other more cosmetic 
footcare subcategories such as foot skincare 
also showing double digit declines. 

Some of the more functional foot 
subcategories, which are less summer 
dependent, are still reflecting growth - with 
blisters and orthotics reflecting the best 
performance. Verucca treatments and corn/ 
callous/bunion treatments are, however, also 
down. This could be attributed to people being 
less likely to treat minor ailments during hard 
pressed times. 

Although chemists enjoyed growth ahead of 
major grocery multiples in 2008, major 
grocery multiples have enjoyed a stronger 
performance into the latest year. This is most 
likely attributed to the impact of the recession, 
where grocery multiples have been better off. 

Pharmacy V Grocery: 
market changes 2008-09 

Total market value 

£19,034,070 down^ 1 


£14,844,330 down ^ 12.6% 

Major grocery multiples 

£3,775,185 down ^ 7.3% 

Best-selling footcare brands 

1. Scholl 

2. Flexitol 

3. CCS 

4. Neutrogena 

5. Compeed 

6. J Pickles 

7. Vaseline Intensive Rescue 

8. Efasit 

9. E45 

10. Gamier Skin Naturals 

Source IRI value sales 52 MHHH^ 

weeks to November 28. 2009 ■ Ih M 

Analysis for C+D provided by ^fclf flBW 

Information Resources (IRI) ■«.~nta>«9Mtai*>. 

footcare sales. Care's Ms Draude and Carnation 
Footcare sales manager Peter Simpson add 
heelcare and insoles (both fashion and 
orthopaedic) to those subcategories making up 
the biggest share of the footcare market. Mr 
Simpson notes: "Corns and callous treatments are 
very buoyant, showing healthy sales growth." 

Target audience 

Three-quarters of people get foot pain at some 
point, according to Care product manager Leanne 
Doughty, which is less than surprising when she 
adds that the average person takes between 
8,000 and 10,000 steps a day - equivalent to 




Five footcare sales tips 

Ask questions about customers' general footcare regime and any other complaints to 
establish how they might benefit from a range of products 

Nominate a staff member as a footcare champion - and advertise their availability 
for a consultation instore 


Encourage use of foot skincare as preventative measures to maximise sales, as other 
subcategories are more problem-solution driven 

Place footcare adjacent to first aid, to link blister product sales, and Scholl footwear 
range if carried 


Organise footcare range into subcategories, such as corn and callous, ball of foot 

walking around the world four times during 
their lifetime. 

Despite this wide market for footcare products, 
Ms Doughty recommends focusing on the needs 
of older customers. "There is a high demand for 
advanced, quality footcare for the 50-plus age 
group," she says, "and painful feet should not be 
accepted by customers as just a natural part of 
getting older." 

She adds that women are four times more likely 
to get foot problems than men, in part due to high 
heel wearing. Mr Simpson agrees: "The current 
popularity of extremely high shoes means that 
podiatrists are seeing a soaring rise in conditions 
associated with poorly fitting footwear. 

"Corns, bunions and blisters - all caused by 
adverse pressure to different areas of the foot - 
are becoming increasingly common. Because of 
this, recommending products that prevent pain 
and damage to the feet is becoming more and 
more relevant in the pharmacy setting." 

Seasonal sales 

High heels are a driver for a seasonal trend for 
footcare during the Christmas party season, says 
Alliance Healthcare's Alphega retail support team. 
"Pharmacies should carry a good supply of blister 
plasters and ranges such as Scholl Party Feet in 

readiness, especially if their store is on a busy 
high street," advises Alphega retail consultant 
Helen Laryea. 

The other major footcare season is summer, 
says Profoot managing director Lewis Freeman, so 
make sure the category is well-stocked and placed 
in a prime position for this peak season. This is 
particularly important if your pharmacy is in a 
tourist hotspot with large numbers of hikers, says 
the Alphega retail support team. Pharmacists 
should ensure the footcare section is visible from 
the door and close to the checkouts, advises Ms 
Laryea. Athlete's foot treatment is in particularly 
increased demand during the summer, adds 
Avicenna retail director Zul Mamon. 

Diabetes link 

Mr Mamon recommends pharmacists take time to 
ask customers making footcare purchases a range 
of questions to identify the correct products and 
any related conditions. He highlights diabetics as 
a particular group to look out for: "People with 
diabetes have an increased risk of infection 
especially in their feet due to poor circulation, 
which can cause healing to be delayed and even 
minor cuts and sores can become infected. This 
can lead to complications if not dealt with 



Boots pharmacist Angela Chalmers, who manages 
the multiple's busy Holloway Road branch in 
London, shares her experience of some of the 
footcare problems she sees most often: 
Fungal nail infection 
Year on year there tends to be much more 
awareness around fungal nail infection; sound 
pharmacist advice on the importance of the 
health and care of nails is important. 
Pharmacists should be able to provide guidance 
on the prevention of such infections, how to 
keep your nails healthy and - for customers 
with an infection - identify the symptoms to 
diagnose a fungal nail infection, and then 
ascertain whether it is treatable at home or if a 
doctor should be consulted. 

We will always be a point of advice and support 
on the treatment of verrucas and there are now 
more treatment options available, with the home 
freezing options becoming increasingly popular. 

Orthotics are becoming increasingly important for 
people with chronic back pain, knee problems and 
fallen arches, and they now come in a wide variety 
to suit the needs of every customer. 

When a customer comes for advice on chronic 
back pain it is important to establish whether the 
pain could be stemming from their feet; as a 
pharmacist it is important to talk through all 
possibilities, especially as orthotics could provide 
some respite without the need for medication. 
I would recommend pharmacists merchandise 
orthotic products next to back pain rubs; the 
packaging often clearly states that they are ideal 
to help those suffering with chronic back pain, 
knee pain and so on. I would also take the 
opportunity to discuss alternatives when a 
customer is purchasing products such as heat 
patches, diclofenac and pain relief medications. 

At this time of year we see more customers 
complaining of chilblains; as such, the pharmacy 
team needs to be equipped for helping and 
supporting customers. If they have poor 
circulation, this can result in painful chilblains on 
both the feet and hands - so provide information 
on the importance of warming up gradually when 
coming in from the cold. 

Brand Watch: Care Advanced Gel Footcare 

Care claims to be the best-selling OTC brand in pharmacy, with one Care product sold "every 
second of the pharmacy working day". And after launching an eight-strong range of footcare 
products a year ago, it says they have been "a runaway success". 

The Care Advanced Gel Footcare range was developed to relieve discomfort in different areas of 
the foot, including corn protectors, toe separators, a bunion guard and metatarsal pads. The brand 
describes the gels as "slim-line", to fit comfortably in most shoes, with "a unique combination of 
minerals and vitamin E"to moisturise and reduce friction and skin irritation. 

On the first anniversary of the Advanced Gels, Care has developed a free merchandiser for the 
range. It is also supported by pharmacy training materials, including foot ailment diagnosis cards, 
and has been recommended in the health pages of Woman's Own magazine. 



Product Watch 




Format: pack sizes of five and 10 

Pip code: 004-3141 (five-pack) 
004-3141 (10-pack) 

RRP: £1.89/£3.40 



Manufacturer: Carnation Footcare 

Classification: GSL 

For: hard corn relief and removal 

Active ingredients: salicylic acid 40 per cent w/w 

P: contains a unique salicylic acid paste (keratolytic) that 
penetrates and helps remove hard corns while the red felt ring 
removes pressure. Clinically proven to remove corns in 10 days 

children under 15 years old and people 
with circulatory disorders should seek professional medical 
advice before use. Contains peanut oil 
Tel: 0121 544 7117 


CCS Heel Balm 

DeWitt (UK distributor: Lornamead) 

Classification: GSL 

For: cracked heels 

Active ingredients: urea 25 per cent 

a purely synthetic version of urea to ensure a high level 
of reproducibility and purity. Works in seven days to repair 
severe rough, dry skin and cracked heels 
Contraindications: none 
Tel: 01276 674000 




Pip code: 


RRP: £2.99 

SoftGel Corn Wraps 

Manufacturer: Profoot UK 
Classification: GSL 
>r: corn relief (also aids removal) 

cutting edge polymer gel technology, 
softens corn and surrounding areas with mineral oil 

slim, low profile fits in any shoe. Washable and reusable 
• anyone with diabetes or poor circulation 
should consult a medical professional before using 
Tel: 020 84921600 

Brand Watch: Carnation Footcare 

I also advise customers to regularly moisturise 
the areas that are painful with a product such as 
aqueous cream, explaining that they should 
massage the cream into the affected area, which 
will help increase blood flow to the affected area 
and stop the skin from forming lots of dry hard 
layers that can add to the pain. 
Cracked heels 

Cracked heel products continue to be of huge 
interest to customers. With increased awareness 
from diabetics on the importance of caring for 
their feet, perhaps as pharmacists we could take 
the opportunity to assist - such as by placing 
cracked heel treatments next to the dedicated 
diabetic products, along with information leaflets 
further explaining the importance that they take 
care of their feet. 

Raj Rohilla set up a one-stop-shop for feet in 
Richmond Pharmacy, Surrey, offering customers 
everything from footwear options to a podiatry 
clinic. Here, Mr Rohilla shares his tips on boosting 
your footcare business: 

Don't put footcare at the front of the shop 

A lot of pharmacies I go into have footcare at the 
front of the shop because it's really only a token 
gesture and can fit well on the end of an aisle. But 
it doesn't look that nice and these purchases 
aren't really impulse buys so do it properly in the 
pharmacy and people will find it. 
Put popular products at the till 
About two years ago I noticed that high street 
fashion stores place Scholl's Party Feet by the till - 
we've done the same and it really works around 
Know your stuff 

People often want advice and reassurance about 
footcare so the supermarkets can't really compete 
with us on it. Make sure you can offer patients 
advice on the category and display it well - you 
can get great looking units now. 
Consider offering footwear 
On the continent pharmacies often stock 
footwear products and our patients have been 
comfortable with it. Plus women will always stop 
to look at shoes! 

Seasonally change the products you display 
most prominently 

j Around Christmas time products for high heels are 
j really popular, and in the summertime everyone 
istarts to think about looking after their feet again. 
Make it your niche 

Year on year our growth has just continued. If you 
can make this your niche and build up a patient 
base for it then it will grow. 

After more than 100 years of providing 
footcare products and advice, Carnation 
Footcare describes itself as "the UK's heritage 
footcare brand". 

Despite the decline in the overall footcare 
market over the past year, sales manager Peter 
Simpson claims the brand has maintained 
"satisfactory growth". He highlights 
treatments and protective foot products 
including Toe Nail Softening Lotion, Verruca 
and Wart Remover Cryospray and Powerstep 
orthotic insoles as particular drivers of growth. 

He puts the brand's continued success in the 
downturn down to a combination of new 

product development and continued support 
for established "customer favourites". 

Its most recent launch was last year's Toe 
Nail Softening Lotion, an OTC treatment 
developed in response to customers' problems 
and pain from hardened toenails. The brand's 
current focus is its Powerstep orthotics line, 
with a new website ( 
that encourages purchases from pharmacy. 

Carnation values independent pharmacy as 
its main line of distribution and last year had a 
marketing budget of £1 million targeted at 
national newspapers and high-circulation 
magazines to drive footfall. 21 

BUSINESS 23.01.10 

How to handle 
your rent review 

Retailers including 
Lloydspharmacy have 
accused landlords of 
using 'archaic' principles 
in rental contracts. 
Property law expert 
Philippa Aldrich 
explains your rights and 
responsibilities when 
yours comes up for 

Rent is usually one of the biggest costs 
for any business, and for a number of 
years landlords have had the upper 
hand as commercial rents have risen ever higher. 
Despite today's recessionary market you, as a 
tenant, may still be hit with a request from your 
landlord for a significant rent increase. Even 
though most commercial leases contain a 
mechanism for the rent to be reviewed at regular 
intervals, usually three or five years, there are 
things you can do - especially as the balance of 
power between tenant and landlord is now 
shifting. Alert tenants may find that now could be 
a good time to negotiate a better deal. 

Your negotiating strength 

Your negotiating strength will depend on two 
factors: your own financial position, and the 
demand for the property in which you are 
operating. In some areas, demand for property is 
still high so there may be fewer good deals to be 
had. In other areas, however, landlords may be 
prepared to negotiate. 
Clearly, the stronger your own business the 

Types of rent review 
Set increase 

Rise in rent over a set number of years 
specified at start of contracts. 


Index such as retail price index inflation used 
as a basis for rent rise calculation - index to 
be used specified at start of contract. 


Landlord takes set percentage of income, 
possibly on a sliding scale over a set number 
of years. 

Upwards only rent reviews 

Otherwise known as open market rent 
reviews, the rent can stay the same or be 
increased, but cannot go down whatever 
scale it is measured against. 

stronger your bargaining position is likely to be; 
landlords will want to keep good tenants in this 
uncertain economic climate. However, even if 
your business is suffering from the downturn, 
landlords may be willing to consider revised terms 
in order to maintain an income stream. 

First, you should have a look at the lease to 
identify the type of rent review being invoked. 
There are several different types of rent review. 

Some leases include clauses that provide for set 
increases in rent. The lease might, for example, 
provide that the annual rent will be £10,000, 
increasing to £20,000 after three years. It is 
unlikely in this case that you will be able to 
oppose an increase in year three as you have 
effectively agreed to it in advance. 

Alternatively, the lease may contain an 
escalation type of rent review where an index, 
such as the retail price index, is used as a basis for 
calculating the rent rise. Again, provided the right 
index has been used and the maths is correct, 
there will be little opportunity for you to object to 
an increase in rent. 

Other rents, particularly in the retail sector, are 
linked to turnover whereby the landlord will take a 
set percentage of the income. The parties might 
also agree a sliding scale of percentages, for 
example charging a different percentage for the 
first year of the lease, to reflect the time you 
spend getting the business up and running. Again, 
while it is worth checking the landlord's 
calculations, it is difficult for you to object to the 

percentage increasing in the second year. 

Rent review clauses should not be read in 
isolation, as other clauses in the lease can also 
be relevant. It is fairly common to see lease 
clauses to the effect that the premises are to be 
used only for a specified purpose, such as for 
retail, or for any other purpose to which the 
landlord gives its written consent. However, you 
should note that if the landlord consents to a 
wider use or a different one, this may affect the 
valuation for rent review purposes. Generally, the 
more uses to which a property may be put, the 
higher the rental value. 

Upwards only rent reviews 

Open market rent reviews are upwards only, that 
is, the rent can stay the same or be increased but 
it cannot go down. These are the most common 
type of rent review. Upwards only rent reviews 
(UORRs) are a major source of controversy in 
today's property market. In a falling market, you 
may end up paying rent that no longer reflects the 
market value of the property and, depending on 
the date of the rent review, be paying the higher 
rent for a number of years. 

Rent review procedure 

Having established what sort of rent review is 
being implemented, the next step is to work out 
what procedure needs to be followed. 

Some leases have long, detailed requirements, 
such as obligations to serve notices triggering the 
review and counter-notices in response from the 
other party. Both sorts of notice may be subject 


For more features and analysis 


Native negotiating power, 
osition versus demand for 

type of rent review is 
• contract. 

to strict time limits. The content, or even the 
precise form, of notices may be prescribed in 
the lease. Complicated procedures such as these 
can be problematical, not least because mistakes 
can be expensive. At worst, if you fail to deliver a 
counter-notice in the right way you may lose your 
right to challenge the revised rent proposed by 
the landlord, however high. 

Sometimes a landlord failing properly to serve a 
trigger notice may lose their right to review the 
rent - but although it is worth checking the lease, 
this is rare. 

When disputes arise 

What happens if you cannot agree terms with 
the landlord? 

The rent review provisions will normally state 
that, if no agreement is reached, the parties may 
refer the dispute to a third party for resolution, 
who will act as either an expert or an arbitrator. 
An expert is usually a surveyor and is appointed as 
an expert in property and possibly even in local 
property in particular. An arbitrator is bound by 
the Arbitration Act and is more like a judge, 
assessing the merits of arguments and evidence 
put to him by each side. 

In each case, comparable rent reviews of similar 
properties will be considered in order to ascertain 
market value. Rent reviews are therefore 
essentially backward looking, which means that 
where rents are likely to fall in the future, 
landlords will be keen to expedite the agreement 
of rent reviews so that they can use as 
comparables rents agreed before the rental 


market began to dip. Equally, it may pay you 
to wait. 

Once the new rent has been agreed, it will 
generally be backdated to the date of the review 
and you will need to pay the landlord the arrears 
together with interest. 

Your oDDOrtimities 

Rent reviews, while mechanical in nature, can be 
used as opportunities to renegotiate with the 
landlord, particularly where you have the benefit 
of a right to break the lease. In a falling property 
market where the landlord is keen to keep you, 
the threat to break the lease might persuade the 
landlord to agree a lower rent. 

If there is no break clause but the proposed rent 
will make continuing with the business difficult, a 
landlord may be prepared to negotiate to avoid 
being left with an empty building. 

However, landlords are always concerned with 
headline rates - they can use these as 
comparables to agree rent reviews on other of 
their properties and they are also key measures 
for valuing the property for investment purposes. 
So sometimes landlords, while insisting on a full 
market rent, may give you other concessions such 
as a rent holiday. 

So if you receive a landlord's rental proposal, 
you should not panic but nor should you delay. It 
is essential to first work out the nature of the rent 
review and then if necessary seek expert advice. 

Philippa Aldrich is a former partner in the Real 
Estate Croup, Shadbolt & Co 

understand your obligations 
in the rent review process, and that you 
comply with all time limits. 

5. If you and the landlord cannot reach an 
agreement, consider referring your dispute 
to a third party. 

6. If you have a contractual right to break 
the lease, consider whether this threat may 
persuade your landlord to consider lower 
rent (see 2). 

7. Take into account other possible 
concessions from your landlord, such as a 
rent holiday, in lieu of a rent reduction. 

Coming up in part 2: how to get 
out of your lease 

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C+D AWARDS 23.01 .1 

To enter the C+D Awards 2010 go to: 


In association with 


I National Pharmacy 
I Association im 

Happy to be 
of assistance 

Becoming Lloydspharmacy's only trained 
phlebotomist gave Sally Ingram a winning ticket. 
She tells Matthew Valentine about her success 

ally Ingram says she sometimes can't 
^\ believe how quickly community 
l^^r pharmacy is changing. And she says that 
the pace of change means career opportunities 
for counter assistants. 

She should know. As well as being the only 
trained phlebotomist within Lloydspharmacy, 
Ms Ingram is currently training to be a pharmacy 
technician. "It means a lot of doors open," she 
says of the changing nature of the pharmacy 
sector. "Your job can grow. There's more to do 
for community pharmacies than there ever 
was before." 

She has seen considerable change to the 
industry and to Lloydspharmacy, which has 
been through a period of growth in the 10 years 
she has worked for the company: "It was a far 
smaller company when I joined." 

"I'm very lucky. I really 
like my job. There are 
always loads of things 
to do, and I also feel like 
I'm in control of what 
I'm doing" 

Organisation is essential to keeping all 
the various services in a modern pharmacy 
running smoothly, and this is one of the areas 
that Ms Ingram excels in. She has put this skill to 
good use, transforming her branch into the 
company's quality benchmark - a "centre of 
excellence" - including achieving a 30 per cent 
increase in dispensing volume and a 13 per cent 
rise in OTC sales. 

As a result, she tends to spend one day a week 
travelling around other local branches of 
Lloydspharmacy within the same management 
cluster of stores, to help spread best practice. "But 
I get quite a few phone calls every day. It's 
interesting, I like going around other shops and 
seeing how things are done there," Ms Ingram 
says. "I'm very lucky. I really like my job. There are 
always loads of things to do, and I also feel like I'm 
in control of what I'm doing." 

Being happy doesn't mean an end to trying new 
things, part of the reason she was chosen as C+D's 
Pharmacy Assistant of the Year 2009. "I've just 
put forward an idea," says Ms Ingram. "Each week, 
everybody is supposed to have a minimum of 15 
minutes of training. If we had specific tasks it 
could be used more effectively," she says. 

Her proposal would mean that the company's 
daily newsletter would feature a training task 
for counter staff: "For example, it could suggest 
we all spend 15 minutes learning about the 
Tens machine." 


Sally Ingram (pictured above left) 


Lloydspharmacy, Earlsdon, Coventry 

Award won 

C+D Pharmacy Assistant of the Year 2009 

Award entry 

Transforming her branch and becoming the 
company's only trained phlebotomist 

Best part of winning 

Ms Ingram's son went to Lloydspharmacy 
head office for a week-long sixth form 
work experience placement. He was 
introduced to everybody as the son of his 
award-winning mum 

Entry for the 2010 C+D Pharmacy Assistant 
of the Year Award category, sponsored by 
P&G Pharmacy Care, is now open. Go to 

for full entry details, hints and tips, to 
download an 
entry form or 
enter online. 


How Sally won the C+D Pharmacy Assistant of the Year Award 2009 

What challenges did you overcome to win 
the award? 

"The phlebotomy service is complicated, it 
can be quite difficult," says Sally Ingram. The 
service, part of a local PCT pilot, is almost a 
victim of its own success, as more than 100 
appointments are kept each week. It runs 
Monday to Friday, from 9am until noon. "We 
are fully booked weeks ahead. People don't 
want to go and wait for three hours at the 
hospital for a blood test when they can just 
book an appointment here. We could do it all 

day, every day, and still be fully booked." 

Keeping the booking system organised and 
managing appointments carefully to avoid a 
backlog in the pharmacy is essential. "If we are 
doing 13 or 14 blood tests every morning, 
that's an extra 13 or 14 people coming up to 
the desk to say they are here, plus 10 to 1 5 
people coming to ask if we can squeeze them 
in," says Mrs Ingram. 

Appointments are staggered to avoid queues. 
"At the end of the day it is a pharmacy first," 
says Mrs Ingram. "We're lucky in that we've got 

a big shop. Smaller shops would find it difficult. 
We are quite organised here so we manage it. 
I'm looking to extend the hours because of the 
amount of people we have to turn away." 

How did you come to enter the C+D Awards? 

"My area manager nominated me. He phoned 
up to suggest that I enter, then we filled out the 
form. Head office were really good, they dealt 
with everything. I just turned up for the 
evening," says Ms Ingram of the support she 
received within the company. 


Hundreds more jobs online 


0207 921 8123 

Booking and copy date 
12 noon Monday prior 
to Saturday publication 
subject to availability 



For a busy pharmacy in East London (E1) 
Part or fully trained (NVQ 2 or 3) 
Applicants must be motivated, enthusiastic, 

customer friendly and hard working. 
Please phone Raj on 020 7488 9364 (daytime) 
020 8989 4312 (evenings) 




(Qualified, NVQ 2-3 or NPA) 
Applicant must be motivated and hard working. 
A Growing Independent Family Run Pharmacy. 
High rewards and satisfaction! RPSGB fees paid! 
Please contact Mitesh on 01202 573 191 


Required for St Helens and Wigan 
independent pharmacies 


Please contact Jon Simpson on 

07918 745343 or 01704 896715 

Email: jon 1 5 1 






Fax: 01268 781623 (NATIONAL LOCUMS) 

Contact: Andrew Walker 
Tel: 0207 921 8123 
Fax: 0207 921 8136 

Ludgate House 
245 Blackfriars Road 
London SE1 9UY 

Liskeard & East Beckton 

Day Lewis is the UK's largest independently owned 
pharmacy group with over 160 community pharmacies 

We currently have opportunities for experienced 
PHARMACISTS to work in the following branches: 

Liskeard - Fairly busy branch close to the local GP. The 
branch offers a number services and would be suited to 
a pharmacist with experience in professional service. 
We have an excellent team supporting the Pharmacist 
MUR accreditation required. M 

East Beckton, London - This 
attached to a GP surgery 
The successful candidate v 
dossett boxes and manager 
INR clinic and would be s 

is a busy branch 
vith an energetic team, 
ill have experience with 
ertt. This branch has an 
itable for a pharmacist 

with an interest irithe professional services. 

We offer our all our pharmacists excellent development 
and support within the company. 

For a call back send your contact details to 
Or call 0208 2566 222 



Pharmacy Technician 

Full Time Position 

Should have NVQ 2/3 or equivalent 

Drury's Pharmacy - 01637 872589 

CV to Liz Nickels 
1 Chester Road, Newquay TR7 2RT 
or email 



NVQ 2/3 for Pharmacy 
in GP Surgery 

Apply to: Mr Basra 
29 Upper Tachbrook 

Street, Victoria, 
London SW1V 1SW 

Tel. 020 7828 1222 

485 jobs 



JOBS 23.01.10 

Browse jobs, upload your CV and get careers advice 



The schools are closed 
because of bad weather. 

Can I take time off to look after 

my children? 

Employment lawyer Careth 
Edwards (pictured) responds: 

are closed, 
may be 
entitled to 
time off 
work for 
But this right 
goes further than covering just 
children. An employee is legally 
entitled to take a "reasonable" 
amount of time off work to deal 
with emergencies involving any 

A dependent is an employee's 
spouse, civil partner, children, 
parents, anyone who lives in the 
same household (excluding tenants 
and lodgers) as the employee, and 
those who reasonably depend on the 
employee to make arrangements for 
the provision of their care. 

An employee is only entitled to 
time off for dependents in certain 
situations, two of which may be 
applicable in snowy or other bad 

because of the unexpected 
disruption or termination of 
arrangements for the care of a 

to deal with an incident that 
involves a child of the employee and 
that occurs unexpectedly in a period 
during school hours. 

There is no set answer as to when 
a situation will be an emergency. 
Recently, tribunals have made clear 
that one factor that is particularly 
relevant to the question of whether 
or not an employee is entitled to 
time off for a dependent is the 
amount of time between an 
employee knowing that there is a 
risk of disruption and the risk 
becoming fact. 

This right exists regardless of 
length of service and whether or not 
they are employed on a full or part- 
time basis. The self-employed are 
excluded from the right to time off 
for dependents. 

Work and weather 

What happens if you can't get to work because of snow or flooding? 
Employment lawyer Gareth Edwards explains your rights 

Over the past month, 
visitors from the Antarctic 
may have felt quite at 
home in the UK, as some of the 
worst winter weather for decades 
hit the country. And it was all too 
familiar, as it was only in February 
last year that we got our heaviest 
snowfall for 18 years. In both these 
instances, thousands were unable to 
travel to work and hundreds of 
schools and businesses were shut. 

Snow isn't the only weather 
phenomenon that businesses battle. 
Consider November, when Cumbria 
was devastated by a once-in-a- 
thousand-year storm that drenched 
the area. And in June 2007, severe 
flooding in south west England, the 
Midlands, Yorkshire and Humberside 
killed 13 people and left 48,000 
homes and 7,000 businesses deluged 
with water. 

So, with official weather warnings 
remaining in place across the 
country - including for more snow as 
C+D went to press - what should 
happen if employees are unable to 
come to work because of adverse 
weather conditions? 

If I can't get to work, will I have to 
take annual leave or lose pay? 
The starting point is that employees 
are only entitled to be paid for the 
work that they do. If employees are 
unable to get to work, or cannot 
carry out their work, an employer 
does not have an obligation to pay. 

Employers should consider the 
employee's contract of employment 
and any workplace policies that 
apply. Some employers will already 
have bad weather policies in place so 
that those who are unable to work 
because of snow or the like know 
whether they will still be entitled to 
pay. Employers who do not have a 
bad weather policy should consider 
introducing one, so that employers 
and employees know their rights. 

Any widespread disruption and 

Travelling may be treacherous but your 
employer may expect you to be in work 

warnings not to travel unless 
necessary may make it very hard for 
an employee to travel to work. 
Some discretion may need to be 
exercised by the employer even 
when a policy is clear. 

Surely some people just use bad 
weather as an excuse not to come 
to work? 

One of the most effective ways that 
employers have found in reducing 
this problem is to tell employees 
that any further days off work will be 
deducted from annual leave, or 
taken as unpaid leave. This may be 
draconian where the weather causes 
widespread disruption, but it is likely 
to help those 'on the fence' where 
there is some bad weather, but it is 
not reported as causing disruption. 

Can I work from home to avoid 
travelling in poor conditions? 
Employers should consider allowing 
employees to work from home. 
Employers need to look at: the 
contract of employment and any 
internal policies; the type of work 
employees carry out; and the 

facilities needed to enable them to 
work from home. In weather 
conditions such as we have seen 
recently, and those in February 
2009, employers may be considered 
by a tribunal to be unreasonable if 
they refuse to allow an employee to 
work from home where it is possible 
for the employee to do so. 

Allowing employees to work from 
home on occasions where there is 
widespread disruption together with 
advice to avoid travelling can help 
employers avoid any potential 
health and safety issues. Employers 
have a duty of care towards their 
employees and it is not necessarily 
in an employer's best interests to 
place employees under pressure to 
travel to work where the advice from 
authorities is to avoid travelling. 

Can employers tell employees 
not to come to work and 
subsequently penalise them? 

Although there is no concrete 
answer, such an approach is not 
likely to be well received. When the 
snow in February 2009 first hit, 
members of the Transport Salaried 
Staffs Association, who work on the 
London Underground, were told not 
to go to work because the buses and 
most of the tubes were not 
operating. The employees have since 
been told that the time away from 
work must be taken as unpaid leave, 
or deducted from annual leave. 

Are employers under a duty to 
pay expenses to employees 
resulting from the bad weather? 
There is no duty on employers to pay 
expenses to employees that occur as 
a result of the bad weather, such as 
overnight accommodation if an 
employee becomes stranded on 
their way to or from work, unless the 
contract stipulates otherwise. 
Careth Edwards is a partner in the 
employment team at Veale 
Wasbrough Lawyers 

Career tip of the week 

"Asking questions invariably takes the heat out of potentially explosive situations. 
It gets people to switch their attention from the main argument to a detail" 
From the Rules of work, by Richard Templar 


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0207 921 8123 

Contact: Andrew Walker 








If you are planning to sell your pharmacy you should be 
preparing for it now. 

Call us today for a no obligation confidential discussion: 
We can provide:- 

• An up to date appraisal of the market 

• A free valuation of your pharmacy 

• A comprehensive list of information and 
documents you will need to provide to buyers. 

• Tips on how to achieve TOP price 

We look forward to receiving your call 

01494 722224 

" We are the only NPA 
approved supplier for 
selling your pharmacy" 

Hutchings Consultants Ltd 


I National Pharmacy 
I Association mm 

Approved Supplier 

allan orme 

pharmacy sales & valuations 

We have over 900 people on our register, from all over 
Great Britain, wanting to buy a pharmacy. If you are 
thinking of selling, give us a call to talk about 
your next step. 

Call 07767 611774 or email: 
A C Orme, Cornerstones, Lime Walk, Dibden Purlieu, 
Southampton S045 4RB 

Worried about the Credit Crunch? 

DTP Will it get better? 

Quick sale guaranteed! 

For further information please contact 
Colin Caunce on 07966 524162 

the legal prescription 

Cost effective specialist legal advice 
to independent retail and community 

We can assist with buying, selling, merging 
and demerging pharmacy businesses as 
well as related leases, sales and purchases 
of commercial premises 




Hilary D'Cruz or Jas Singh 
01543 466 660 


FREE sexual 
health leaflets 

Marie Stopes International are experts in sexual 
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If you would like leaflets about unplanned 
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020 7034 2382 /S 





V Pharmacy Development Group 

Gain the benefit of share of profits without 
having to invest your own money in a 
share purchase scheme 

Trading group terms aggregated discount up to 
the equivalent of 12.98% from zero threshold 


Find new ways to influence your profit 

Your pharmacy website home page to promote 
your services 

Full support on Pharmacy New Contract allowing 
members to implement new opportunities 


Call Freephone 0800 526074 & ask for Customer Services 
quoting reference No. CDJAN 
Or Fax on 01530 814914 Or Email 



New jobs each week 




Celsius indication 
Beeps when ready 
Last measurement recall 

tel: 020 8204 2224 • fax: 020 8204 0224 • web 

Offer applies to purchases made between 23rd January 2010 -26th February 2010 

E&Ot • Ne! p'rces ere (jHer se'tlernc'' discount 2.5% • Goods sypject 'o avat'aoi'ity • VAT ol standard rate 


Pharmacy design and shopfitting 
without compromise 
O 8 4 5 450 5904 


Let us help you to maximise your 
profits by grooming your business for 
future sale. 

We can advise you on: 

How to structure your business to 
minimise your tax bill when you sell. 

Increasing your turnover. 

Increasing your gross margin. 

Monitoring your expenses. 

Benchmarking your business against 
similar pharmacies. 

For more information please visit: 

or contact Anne Hutch ings on: 
01494 722224 

Facsimile: 01494 434764 

Leading Tax Consultants and 
Accountants for Pharmacies 

jniuc cuveraye 
Concept, design a planning 
Manufacture, fitting a installation 
The Pharmacy refit specialists 

28 ' 

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cto 10% 

• Maximise the sale price 

• Reduce your Capital Gains Tax to 1 0% 
of the gains 

• Plan to minimise Inheritance Tax liability 

• Introduce you to potential buyers on 
our database 

• And much more... 

^faelling my pharmacy could have been a 
very stressful process. However Modiplus 
helped me to sell my business by 
maximising my tax savings. It's the best 
step I have taken by appointing Modiplus 
to act for me while selling my busine^M 


For more information or for a FREE 
consultation please call Umesh on: 

020 7383 3200 

Member of Silver Levene Group 





Health Aid 

Looking Good, Feeling Great! 

w |ance , d •./itam in , „ 

For further information please contact us 
Tel: 020 8426 3400 

This product has not been proven to contribute to hair health 

Tired of taking 
the same route? 

Let C+D jobs provide an 
effective alternative. 

To advertise your vacancies visit 29 


Got a story for Postscript? 

"They enter this 
vocation through 
apprenticeship, with 
the idea that the life 
of a druggist is a 
light, genteel 
business, free from 
arduous labour" 


I write to protest against the greatest evil 
of our profession, one which, if removed, 
would be a great boon to all. I refer of 
course to the necessity of remaining open 
on a Sunday. 

Druggists are persons of education, 
intelligence and respectability. They enter 
this vocation through apprenticeship, with 
the idea that the life of a druggist is a light, 
genteel business, free from arduous labour. 

It is monstrous that such a class is 
subjected to what they endure daily! I am 
perfectly assured that no necessity exists 
to open our shops from early in the morning 
to late at night, on Sundays as well as 
week days. 

Of course I believe it the duty of every 
druggist to supply necessary medicines to 
the public at all times, and if my proposal 
were injurious I would not advocate it. But 
nine out of 10 customers are not in urgent 
need, and merely want perfumes, capers and 
smelling bottles! Could not persons in need 
ring the shop bell, and could we not post a 
notice on the door stating only necessary 
medicines would be supplied? 

I engage to say that if my plan were 
adopted, in three months there would be 
very few unnecessary rings of the bell, and 
the Sabbath would become, as it ought, a 
day for rest and spiritual improvement. 

The Victorian Pharmacist's comments are 
based on a letter to C+D from 1860 that 
complained about Sunday opening. How 
have things changed? Do you keep your 
pharmacy open on Sunday? Let us know 

W UbLoLl ID I 

The great book giveaway 

C+D is moving offices next month, and Postscript 
has too many books, manuals, guides, digests and 
hulking tomes for its new cubby hole. So we're 
giving away everything we're not taking with us. 

Highlights of the manuals on offer include a 
copy of Martindale, guides to just about every 
specialist area you could think of, and a complete 
1980 British Pharmacopeia (with all the addenda). 

But we're not just handing them out for free - 
where's the fun in that? To kick off the great C+D 
book giveaway, we are offering a copy of 
Martindale 33, and we want you to send us a 
picture of you in your pharmacy. It doesn't matter 
if it's a photo or a doodle using Paint, the best 
picture, as judged by Postscript, will get the book. 
Email your entries to 

Lies, damn lies and statistics 

Have you ever wondered how many people in 
your pharmacy will live to 100, have raised 
cholesterol or have an STI ? Thanks to a new gizmo 
on the internet, you can now work it out. 

The Chances Are... calculator, developed by 
Lloydspharmacy, lets you tailor national statistics 
to your pharmacy staff, estimating the prevalence 
of everything from STIs to the number of colleagues 
who have had romantic flings with each other. 

Postscript couldn't resist trying the calculator 
out on the C+D office. Apparently 10 of us have 
herpes, four of us are obese, 10 of us have trouble 
sleeping and one of us is sleeping with the boss. 

Postscript doubts that's accurate, but to try the 
calculator for yourself, go to 

C+D Reader of the week 

Meet scuba-diving Phil Bullen of Wellness Pharmacy, Cardiff, and find 
out what he discovered off the coast of Cornwall. 

Why did you become a pharmacist? 

I enjoyed science, and interactions between 

If you weren't a pharmacist, what would 

you be? I'd run my own diving school in 
the Caribbean. 

What's the most interesting thing 
you've done? I was involved in Channel 4's 
Wreck Detectives. I trained the presenter and 
safety team in Trimix scuba diving, and was part 
of the team. We identified a first world war 
submarine off the coast of Padstow. 

Weirdest request you've ever had? Someone 
who asked for anaesthetics for fish. I thought: 
why would you want to anaesthetise a fish? 

What service would you like to see 
nationally? Personally it would be an anti- 
obesity service, as I'm interested in fitness. 

What should we ask the next interviewee? 

Where is the future of retail pharmacy going? 

Calling all pharmacists and technicians. We 
want you to be our reader of the week. Email 
us at to take part 


counter staff 
in 2010 

ne d about my 


cow „ "».»,n, „„,„ 

• 36 modules per year 

• Modules cover common OTC 
therapy and practice areas 

• Modules delivered monthly in 
OTC magazine and online 

• Telephone assessment with 
immediate results 

• Certificates of completion sent 
out every six months 

• Keeps your staff 
knowledgeable and up to date 

• Cost-effective - as little as 
£10 per staff member 

Call 01732 377269 
I to register 



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